Opinion ID: 1608158
Heading Depth: 1
Heading Rank: 7

Heading: less restrictive treatment alternatives

Text: Kochner next argues that the Board's order violates the Commitment Act because the State failed to show by clear and convincing evidence that treatment alternatives less restrictive than commitment for inpatient treatment were available. Section 83-1038 provides in part: The disposition ordered by the mental health board shall represent the alternative which imposes the least restraint upon the liberty of the subject required to successfully treat the particular mental illness and prevent the particular harm which was the basis for the board's finding the person to be a mentally ill dangerous person. The board shall consider all treatment alternatives, including any treatment program or conditions suggested by the subject, the subject's counsel, or any interested person, including outpatient treatment, consultation, chemotherapy or any other program or set of conditions. Full-time inpatient hospitalization or custody shall be considered a treatment alternative of last resort. To support his claim, Kochner relies upon Ritchie's testimony. She recommended that Kochner be placed in an outpatient program in which he would be closely supervised and receive services and case management equivalent to intensive supervised parole. The program envisioned by Ritchie would have placed numerous restrictions on Kochner, including: a. living in a supervised community residence and 100% compliance with all their rules and regulations, b. 100% attendance and active participation in intensive outpatient individual sex offender treatment.... .... e. random urinalysis for substance abuse and random liver enzyme assays for alcohol use. f. the appointment of a guardian to manage his affairs including personal and financial decision-making.... .... h. an agreement by [Kochner] and all immediate significant others that he will be required to take steps to actively avoid any and all contact with children.... i. an agreement by [Kochner] that he is never to be alone with children under any circumstances, and that in those circumstances where he cannot avoid being in the presence of particular children ... he is supervised by an awake, informed service provider or other awake, informed person [sic] approved by his clinical team[.] Ritchie conceded that no program like the one she envisioned existed in Lancaster County, but testified that the county could develop such a program with a variety of mechanisms and resources available to it. The Board rejected Ritchie's hypothetical outpatient treatment program and determined that inpatient treatment was the least restrictive treatment alternative available. It noted that it knew of no outpatient treatment program that would have included the physical constraints envisioned by Ritchieparticularly those that required Kochner to stay away from children. It also reasoned that the close supervision and specially designed sex offender program envisioned by both Dr. Paine and Dr. Ritchie is [sic] virtually impossible in any environment except the Lincoln Regional Center program. In reaching its decision, the Board relied primarily on Paine's testimony that inpatient treatment was the least restrictive treatment option. Kochner argues that Paine's testimony is insufficient to support the Board's conclusion because the only basis for her opinion was that no current outpatient program in Lancaster County would accept Kochner. This argument, however, mischaracterizes Paine's testimony. She did testify that because Kochner had consistently denied or minimized his previous offenses, she was not aware of any outpatient sex offender program in Omaha or Lincoln which would accept him. But that was not the sole basis for her opinion. Paine also testified that the level of risk presented by Kochner was too high to place him in an outpatient program, even one with the restrictions suggested by Ritchie. Moreover, she pointed out that Kochner lacked any insight whatsoever in[to] his sexual deviancy and was non-disclosing regarding the majority of his sexual thoughts and urges. In Paine's opinion, these two factors meant that Kochner would be unable to identify and report the symptoms of his mental illness in an outpatient regimen and that therefore the greater degree of supervision associated with an inpatient program was warranted. Finally, Paine noted that Kochner also suffers from cognitive disabilities as a result of a head injury he suffered as a teenager and that the inpatient sex offender program at the Lincoln Regional Center was specifically modified to treat such individuals. Upon its de novo review of the record, the district court agreed with the Board's conclusion that commitment was the least restrictive treatment recommendation. Given Paine's testimony, the district court did not err in reaching this determination.