Opinion ID: 4358149
Heading Depth: 2
Heading Rank: 1

Heading: Naomi B.1

Text: In January 2015 Adult Protective Services petitioned for an ex parte order committing Naomi B. to the Alaska Psychiatric Institute (API). She agreed to stay voluntarily and to take medication, attend groups and meetings, and plan for her discharge. But after her admission she refused to take medication or participate in treatment. Naomi’s state soon worsened. She reported being repeatedly raped, hit, and assaulted, but API found no evidence to support her allegations after conducting a physical exam and reviewing tapes from the facility’s surveillance cameras. Her treating psychiatrist, Dr. David Mack, concluded that Naomi’s reports were delusions caused by mental illness, and he diagnosed her with schizoaffective disorder, bipolar subtype. 1 Pseudonyms have been used throughout this opinion to protect the privacy of the parties. -2- 7328 Naomi never demanded to be discharged from API, and while she ate and maintained her personal hygiene, she could not or would not cooperate with API staff to plan for her discharge. Concerned that she could not manage her treatment or housing outside of API, hospital staff filed a petition later that month to involuntarily commit Naomi for 30 days. The petition alleged that Naomi was “gravely disabled and there [was] reason to believe that [her] mental condition could be improved by the course of treatment sought.” API also petitioned the court to approve involuntary administration of psychotropic drugs. That same day a magistrate judge held hearings on both petitions. Naomi was represented by an attorney at the hearings, but declined to participate in person. The court visitor2 testified that Naomi had refused to meet with her, that she was therefore unable to offer an opinion about Naomi’s capacity to give informed consent to medication, and that she had been unable to find any advance health care directive in Naomi’s medical records.3 The court next addressed the involuntary commitment petition. Dr. Mack testified that outpatient treatment would not be adequate for Naomi because she was “at great risk for exposure to disorganized, aggressive behaviors if she’s not surround[ed] by a professional staff.” Dr. Mack also indicated that Naomi was “unable to engage with [API’s] treatment team on basic needs due to her delusional construct” and that API had not been able to confirm that Naomi had a safe place to live. As a result he believed 2 When an involuntary medication petition is filed, the superior court is required to appoint an independent court visitor to assist in investigating whether a patient has capacity to give or withhold informed consent to the administration of psychotropic medication. AS 47.30.839(d). 3 An advance health care directive could have indicated Naomi’s position regarding psychotropic medication. See AS 47.30.839(d)(2). -3- 7328 there was no less restrictive placement where Naomi could receive treatment. The court granted the petition, finding that Naomi was “mentally ill and, as a result, gravely disabled,” and that there was no less restrictive treatment alternative. The court then turned to the petition for court approval of administration of psychotropic medication. Dr. Mack testified that API sought to administer two medications to Naomi: olanzapine, an antipsychotic to address her delusions, and lorazepam to reduce anxiety and irritability and to treat some side effects of olanzapine. Dr. Mack acknowledged risks associated with both medications but concluded that the benefits outweighed the risks. He hoped that the medications could improve Naomi’s condition within a week. He believed that Naomi had no ability to give or withhold informed consent to the administration of the medications, that the medications were in her best interests, and that there was no less intrusive means of treating Naomi’s schizoaffective disorder. He also said that Naomi would be offered various forms of group treatment to help her manage her illness, but that the group therapies alone would not successfully treat Naomi’s disorder. The court granted the petition for medication “with the amendment that the lorazepam [was to be administered] only as needed.” Naomi’s lawyer did not question witnesses, raise objections, or make any arguments to the court. The magistrate judge issued a written report detailing the factual and legal findings from the hearing; the superior court adopted the magistrate judge’s recommended findings and signed the attached orders in February. Naomi appeals, arguing that the superior court erred in finding that she was gravely disabled, that there was no less intrusive alternative to involuntary medication, and that forced medication was in her best interests. Naomi requests that we reverse or vacate the commitment and medication orders. -4- 7328