Opinion ID: 2586091
Heading Depth: 3
Heading Rank: 2

Heading: The Petition for Administration of Psychotropic Medication

Text: Wetherhorn raises two challenges specific to the petition for the administration of psychotropic medication. Both of these challenges are affected by our decision in Myers v. Alaska Psychiatric Institute, [56] which had not yet been decided at the time of Wetherhorn's hearing.
Alaska Statute 47.30.839(d) provides that when a petition for the involuntary administration of medication is filed, the court must direct OPA to provide a visitor to assist the court in investigating the issue of whether the patient has the capacity to give or withhold informed consent to the administration of psychotropic medication. Here, the superior court appointed OPA, as required, but no visitor's report was presented during the hearing and there was no reason given for the failure to present it. API concedes that an obvious mistake was made with regard to the statutorily-required court visitor report and agrees that the requirement of a visitor's report is mandatory. API nevertheless attempts to explain that the lack of a visitor's report was an inevitable and regrettable consequence of the timing of events, because in Wetherhorn's case the hearing was held on the same day that the petition was filed and OPA was appointed as visitor. API insists that [t]his schedule permitted no time for the court visitor to fulfill its statutory obligation. But this was a petition for the involuntary administration of psychotropic medication in a non-emergency situation. Unlike involuntary commitment petitions, [57] there is no statutory requirement that a hearing be held on a petition for the involuntary administration of psychotropic drugs within seventy-two hours of a respondent's initial detention. The expedited process required for involuntary commitment proceedings is aimed at mitigating the infringement of the respondent's liberty rights that begins the moment the respondent is detained involuntarily. In contrast, so long as no drugs have been administered, the rights to liberty and privacy implicated by the right to refuse psychotropic medications [58] remain intact. Therefore, in the absence of an emergency, there is no reason why the statutory protections should be neglected in the interests of speed. As API itself concedes, a hearing on a medication petition should be continued rather than proceed without a visitor's report. Furthermore, the court visitor's report is no mere technical requirement. As we explained in Myers, psychotropic medications are highly intrusive medications [59] and have been equated with the intrusiveness of electroconvulsive therapy and psychosurgery. [60] Alaska requires a two-step process before psychotropic drugs may be administered involuntarily in a non-crisis situation: the State must first petition for the respondent's commitment to a treatment facility, [61] and then petition the court to approve the medication it proposes to administer. [62] The second step requires that the State prove by clear and convincing evidence that: (1) the committed patient is currently unable to give or withhold informed consent; [63] and (2) the patient never previously made a statement while competent that reliably expressed a desire to refuse future treatment with psychotropic medication. [64] In order that the court may make an informed decision concerning these two issues, the court visitor is appointed to assist the court in investigating the issue of whether the patient has the capacity to give or withhold informed consent by evaluating the patient's responses to a capacity assessment instrument administered at the request of the visitor [65] and to document any expressed wishes of the patient regarding medication, including wishes that may have been expressed in a power of attorney, a living will, an advance health care directive . . ., or oral statements of the patient. [66] The visitor's report is therefore essential to the court's mandatory duty to determine whether the patient is presently competent to provide informed consent [67] or, if the patient is determined not to be presently competent, to decide whether the patient was competent to provide informed consent at the time of previously expressed wishes to refuse psychotropic medication. [68] The prejudice to the respondent whose case is decided without the visitor's report is clear. Because the visitor's report is an essential component of the statutory scheme, the failure to prepare and present the report before the hearing in Wetherhorn's case is an instance of plain error.
Wetherhorn additionally argues that the evidence presented with regard to the petition for the involuntary administration of psychotropic medication was insufficient to meet the clear and convincing standard. As an initial matter, the issue is again moot with regard to Wetherhorn because the facts given in support of the need for medication are specific to a certain time and place as was the case of the petition for thirty-day commitment. Nevertheless, in light of our decision in Myers, the court must in non-emergency cases make specific findings: (1) that the respondent is incapable of giving or withholding informed consent and has not made a previous statement while competent expressing a choice; (2) that the proposed treatment is in the respondent's best interest; and (3) that no less intrusive alternative is available. [69]