Opinion ID: 2646300
Heading Depth: 1
Heading Rank: 1

Heading: facts

Text: In 2004 Stephen O. heard “voices that told him to jump off a wall.” He obeyed the voices1 and, in an apparent suicide attempt, “jumped off a ledge some 16 to 18 feet high.” He broke his ankle, gashed his head, sustained a concussion, and was temporarily wheelchair-bound as a result. This incident occurred at a hospital in Olympia, Washington; Stephen had been taken to the hospital by members of a church after he asked them to take him to a doctor. Following this incident, Stephen began receiving Social Security disability benefits for psychiatric illness. He was also prescribed Resperdal, an antipsychotic medication, which he took for approximately one to two years following this psychotic break. 1 Testimony at the commitment hearing was unclear as to whether Stephen heard the voice of Jesus or the voice of Lucifer. -25- 6857 In January 2010, Stephen’s father became concerned about him again after Stephen’s daughter reported that he was “creeping [her] out.”2 Stephen had begun waking his children up at night and talking to them about God, attending church, and following “a path of repentance.” Stephen’s father and daughter were alarmed because this behavior was very similar to Stephen’s behavior in his previous psychotic break, where he reported hearing voices and “heading down a path of repentance” and then severely injured himself. Stephen’s mother also considered this behavior to be abnormal because prior to early January 2010 she did not consider him to be a religious person. Concerned for his safety, Stephen’s parents reported his behavior to a community mental health clinician, who filed a petition for initiation of involuntary commitment on January 8, 2010. The petition identified the following facts that required an evaluation: “Client is presenting with psychotic features including hearing the voice of Jesus. Client exhibits behaviors similar to those he has exhibited in the past, prior to a suicide attempt.” On January 8, 2010, the Haines Police Department took Stephen into emergency custody under AS 47.30.705(a).3 The following day, Master Bruce 2 Neither Stephen’s father nor daughter testified at the hearings in the superior court. Instead Stephen’s father reported his reasons for seeking involuntary commitment to Dr. John Pappenheim, Stephen’s treating physician at Bartlett Regional Hospital. 3 Alaska Statute 47.30.705(a) provides in relevant part: A peace officer, a psychiatrist or physician who is licensed to practice in this state or employed by the federal government, or a clinical psychologist licensed by the state Board of Psychologist and Psychological Associate Examiners who has probable cause to believe that a person is gravely disabled or is suffering from mental illness and is likely to (continued...) -26- 6857 Horton of the Sitka Superior Court issued an ex parte order to have him taken into custody and transported to Bartlett Regional Hospital in Juneau, “the nearest appropriate evaluation facility,” for an evaluation as provided for in AS 47.30.710(a).4 Stephen remained in the Haines jail from January 8 to January 14 because bad weather prevented his transportation to Juneau for evaluation. He arrived at Bartlett Regional Hospital on January 14, 2010. He was evaluated the next day by Dr. John Pappenheim, the medical director for psychiatric services. A 30-day commitment hearing was set for January 20, 2010. Proceedings On January 20, 2010, Superior Court Judge Patricia A. Collins conducted the 30-day commitment hearing. Dr. Pappenheim and Stephen testified regarding the State’s request for Stephen’s 30-day commitment. The court also considered a report by Elizabeth Ziegler, the court-appointed visitor. On January 27 and 28 the court heard 3 (...continued) cause serious harm to self or others of such immediate nature that considerations of safety do not allow initiation of involuntary commitment procedures set out in AS 47.30.700, may cause the person to be taken into custody and delivered to the nearest evaluation facility. A person taken into custody for emergency evaluation may not be placed in a jail or other correctional facility except for protective custody purposes and only while awaiting transportation to a treatment facility. 4 Alaska Statute 47.30.710(a) states: A respondent who is delivered under AS 47.30.700­ 47.30.705 to an evaluation facility for emergency examination and treatment shall be examined and evaluated as to mental and physical condition by a mental health professional and by a physician within 24 hours after arrival at the facility. -27- 6857 further testimony from Dr. Pappenheim, Stephen, and Ziegler on the State’s petition to administer medication. Dr. Pappenheim gave expert testimony on the diagnosis of Stephen’s mental illness and the risks associated with his behavior. He testified that Stephen “suffers from bipolar affective disorder, current manic with psychotic features.” Dr. Pappenheim’s diagnosis was based “in substantial part” on information he received from Stephen’s father regarding his psychotic break six years prior and on interviews he conducted with Stephen. Stephen’s father reported that during his prior episode of psychosis, Stephen was behaving “in precisely the same fashion” as in early January 2010: “once again [Stephen was] manifesting the presentation of hearing the voice of Jesus, becoming religiously preoccupied, wanting to head down a path of repentance.” Stephen’s father had confirmed that his recent change in behavior was a “substantial and marked departure from his previous condition.” Dr. Pappenheim was concerned because this departure “has historically been associated with behavior that’s very harmful to [Stephen].” Dr. Pappenheim testified that “[Stephen] has a distinctively and abnormally persistent elevation, or expansiveness[,] of mood that’s the singular feature of bipolar disorder.” Dr. Pappenheim explained that Stephen’s “very elevated . . . if not modestly euphoric mood” was indicative of a problem because it was not congruent with the circumstances of Stephen’s unfortunate situation: [I]t’s this . . . completely illogical, irrational response of everything’s great [despite the fact that he’s being held against his will, that] his children are no longer with him, and that his father thinks that he has a mental illness that needs to be treated, and that the psychiatrist that’s been appointed to work with him thinks that he has a mental illness that needs -28- 6857 to be treated, and that [the psychiatrist] thinks he should take medication and [Stephen] doesn’t want to take medication. Dr. Pappenheim explained further that Stephen was incapable of making a decision about voluntary treatment because he was operating under the belief that he does not have a mental illness. According to Dr. Pappenheim, Stephen’s inability to understand his situation and refusal to accept treatment for it constituted grave disability. Stephen refused to take a mood stabilizer and an antipsychotic, which Dr. Pappenheim believed are “requisite treatment[s]” for someone with manic psychosis. Without treatment, Stephen was at risk of hurting himself as he had during his previous episode of psychosis, because “[p]ast patterns of behavior are really the only good predictors of future behavior.” Dr. Pappenheim acknowledged that there were no current allegations that Stephen had failed to care for himself or his children. But, based on the similarity between his current behavior and past episode of psychosis, Dr. Pappenheim explained that Stephen’s refusal to accept treatment “places him in substantial danger of deteriorating condition, the development of a chronic psychotic process, [and] the risk of . . . harming himself.” If Stephen were allowed to leave the hospital, Dr. Pappenheim’s main concern was that his condition would “persist and worsen, [and] that he would at one point listen to a voice that would tell him to do something very dangerous and self harmful.” Dr. Pappenheim characterized Stephen’s condition as a significant impairment. He explained that without treatment Stephen’s condition was “not going to abate” and “there [would] be a chronic worsening” that may develop into “a chronic psychotic process.” Ultimately, Dr. Pappenheim concluded that there was no less restrictive alternative to a 30-day commitment to ensure Stephen’s safety and provide him with requisite care. -29- 6857 Stephen also testified at the hearing. He reported on the breakdown of his marriage and recent events in his life. He disputed his family members’ reports that he had been behaving abnormally and he disagreed with Dr. Pappenheim’s opinion that he was mentally ill. The court also reviewed a report that outlined Stephen’s meeting with Elizabeth Ziegler, the court-appointed visitor. In the report, Ziegler described Stephen as friendly and presenting well. The report noted his description of his previous psychotic break and treatment, and his current objection to taking medication. The report also described his mother’s report of his previous psychotic break, and her concerns about his recent religiosity and behavior toward his children. Acknowledging the “very high burden of proof that applies in this case, . . . clear and convincing evidence,” the superior court found that Stephen was “gravely disabled” under AS 47.30.915(7)(B). The court cited the following facts in support of its conclusion: (1) Stephen’s prior psychotic break, hospitalization, and apparent suicide attempt; (2) his diagnosis of bipolar affective disorder, current manic with psychotic features; (3) his eligibility for and receipt of Social Security disability benefits for psychiatric condition (eligibility which was based on a “stringent test” administered by Social Security); (4) his daughter’s report that he was “creeping [her] out”; (5) his family’s concerns about the similarity between his current behavior and his behavior during his prior episode of psychosis; and (6) his belief that Jesus was telling him that he does not need mental health help. The court ordered that Stephen be involuntarily committed for 30 days. Later, the superior court heard additional testimony on the petition to involuntarily administer psychotropic medication. In the interim, Dr. Pappenheim received records from the hospital in Olympia, Washington, where Stephen was treated during his previous psychotic episode. Dr. Pappenheim testified that the records -30- 6857 strengthened his opinion that Stephen’s hospitalization was appropriate “because of the markedly regressed psychotic state that [Stephen] came into . . . and [his] concern that . . . he would return to that at some point.” The superior court denied the petition to administer medication, concluding that there was not clear and convincing evidence that harm to Stephen was imminent because his mental condition had not deteriorated during the time he was in custody. Judge Collins continued the 30-day commitment order finding that Stephen was still gravely disabled, but declined to permit involuntary medication, noting that there was “an even higher burden that has to be met with respect to administration of psychotropic medications.” On January 29, 2010, Stephen was discharged early because the State’s petition to involuntarily administer medication was denied, he refused to take medication voluntarily, and “gains [would] not be achieved without medication.”