Opinion ID: 2614565
Heading Depth: 2
Heading Rank: 1

Heading: The Circuit Court Possessed The Authority To Issue The Order Permitting The Administration Of Involuntary Medication.

Text: Kotis argues that there was neither statutory nor any other authority for the circuit court's order permitting the director to medicate him involuntarily. We disagree. HRS ง 704-406 expressly provides that, upon a determination that a criminal defendant is unfit to proceed, the court shall commit the defendant to the custody of the director of health to be placed in an appropriate institution for detention, care, and treatment.  (Emphasis added.) Both the plain language of HRS ง 704-406 and its legislative history are silent as to whether detention, care, and treatment may include a court order authorizing the involuntary administration of antipsychotic drugs. Common sense, and an analysis of other statutes in pari materia, however, demonstrate that such an order is included within the authority vested by HRS ง 704-406. HRS ง 334-34 (1993) provides in relevant part that [t]he director of health shall be responsible for the safekeeping of all patients who may be admitted to the state hospital and for the enforcement of proper order among and concerning the patients. The director's motion in this case alleged that it was necessary to medicate Kotis involuntarily because of the danger he posed to himself and to others in the hospital. Thus, the circuit court's order appears to be justified by the director's statutory responsibility for Kotis's safekeeping and for the maintenance of proper order among and concerning the patients. Kotis argued in the circuit court that his informed consent was required before being administered any medication pursuant to HRS ง 334E-1 (1993), which provides in relevant part that, [b]efore any nonemergency treatment for medical illness can commence, informed consent, as required by section 671-3 [11] and as defined by the board of medical examiners pursuant to the authority vested in it by that section, shall be obtained from the patient, or the patient's guardian, if the patient is not competent to give informed consent. (Emphases added.) As Kotis points out, the circuit court did not make any express finding regarding Kotis's competence to give informed consent to his treatment. [12] Moreover, although a GAL was appointed in this case, the circuit court did not appoint a guardian of Kotis's person. [13] Arguably, therefore, the circuit court failed to comply with HRS ง 334E-1 because it failed to obtain Kotis's informed consent. However, HRS ง 334E-2 (1993), which contains a lengthy list of the rights accorded to [a]ny patient in a psychiatric facility to be exercised either by the patient or by the patient's legal guardian or legal representative, provides in subsection (a)(9) for a right of [r]efusal of treatment except in emergency situations or where a court order exists [.] (Emphases added.) Accordingly, by its express terms, HRS ง 334E-2(a)(9) contemplates a situation, such as the one at bar, in which the circuit court may be called upon to authorize involuntary treatment of the patient, i.e., where neither the patient nor his or her guardian consents to the treatment, even absent an emergency. See also Hawai`i Administrative Rules (HAR) ง 11-175-33(a) (1988) (providing in relevant part that [m]ental health ... programs shall obtain informed consent to treatment ... except for a person specifically ordered by a court to be involuntarily treated  (emphasis added)). [W]here there is a `plainly irreconcilable' conflict between a general and a specific statute concerning the same subject matter, the specific will be favored. However, where the statutes simply overlap in their application, effect will be given to both if possible, as repeal by implication is disfavored. State v. Vallesteros, 84 Hawai`i 295, 303, 933 P.2d 632, 640, reconsideration denied, 84 Hawai`i 496, 936 P.2d 191 (1997) (citations and internal quotation signals omitted). Reading HRS งง 334E-1 and 334E-2(a)(9) in pari materia, therefore, it is apparent that HRS ง 334E-2 carves an exception to the general rule, as set forth in HRS ง 334E-1, that the patient or his or her guardian must consent to a particular course of treatment. [14] Furthermore, construing HRS ง 704-406 in light of HRS ง 334E-2, it appears that the former statute's allowance for detention, care, and treatment of a pretrial detainee may legitimately include seeking court approval for involuntary medication. The Department of Health appears to have arrived at the same conclusion, as demonstrated by HAR ง 11-175-45 (1988), the rule promulgated to enforce HRS ง 334E-2. That rule provides in relevant part: Right to refuse nonemergency treatment. (a) Psychiatric facilities and residential treatment facilities shall establish policies and procedures for exercise of the right to refuse nonemergency treatment by consumers, except consumers ordered by a court to receive specific treatment. ... . . . . (b) When informed consent to proposed treatment is not obtained, the facility shall: . . . (2) Petition for a guardian for the consumer if the consumer has been clinically determined not to have the capacity to make a decision regarding treatment and the consumer does not have a guardian or attorney-in fact, and obtain consent from the guardian or attorney-in-fact before nonemergency treatment begins; [15] or (3) Obtain a specific court order for involuntary treatment if the consumer appears to have the capacity to make a decision regarding treatment and has been ordered by a court to be involuntarily hospitalized. (Emphases added.) Because Kotis was involuntarily hospitalized by order of the circuit court, HAR ง 11-175-45(b)(3) applies to his case and authorizes the director's motion for an order of involuntary medication. Administrative rules, like statutes, have the force and effect of law. State v. Kirn, 70 Haw. 206, 208, 767 P.2d 1238, 1239-40 (1989) (citing Abramson v. Board of Regents, University of Hawaii, 56 Haw. 680, 548 P.2d 253 (1976), and Aguiar v. Hawaii Hous. Auth., 55 Haw. 478, 522 P.2d 1255 (1974)); Baldeviso v. Thompson, 54 Haw. 125, 129, 504 P.2d 1217, 1221 (1972) (citing State v. Kimball, 54 Haw. 83, 503 P.2d 176 (1972)). Kotis has not alleged any infirmity in the promulgation of HAR ง 11-175-45(b)(3). Accordingly, inasmuch as we discern no conflict between HRS ง 11-175-45(b)(3) and the governing statutes, Kotis's argument that the circuit court acted without authority fails.