Opinion ID: 1703516
Heading Depth: 3
Heading Rank: 2

Heading: Facial Constitutionality of AD-11-97 on Substantive Due Process Grounds

Text: ¶ 40 Wood further argues that AD-11-97 fails to comport facially with substantive due process because it does not adequately require a finding of dangerousness before institutional staff may seek an order to medicate or administer medication pursuant to such an order. The State disagrees. It asserts that due process does not require an express finding of dangerousness before seeking an order or administering psychotropic medications to persons committed under ch. 971. It further contends that, to the extent that due process does require such a finding, the directive sets forth standards for a finding of dangerousness that comport with the requirements set forth in Harper. We agree with the State. Due process does not require a finding of dangerousness under the circumstances presented here; however, if it did, we are satisfied that AD-11-97 provides adequate standards for a finding of dangerousness, as explained herein. ¶ 41 As noted previously, AD-11-97 is the protocol for staff at Mendota and Winnebago Mental Health Institute to follow when deciding whether to seek an order to medicate a patient at one of those facilities and whether to administer medication to that patient pursuant to such an order. The directive first requires a treatment team, made up at least of the patient's psychiatrist, a non-physician clinician and a member of the Nursing Staff, to assess the patient's situation before seeking the order. [10] The team must conclude that the patient meets all four of the following criteria: (1) the patient is not competent to refuse medication; (2) medication serves the patient's medical interests; (3) the patient meets the `dangerousness' standard; and (4) no acceptable alternative means are available to address the patient's dangerousness. [11] Furthermore, AD-11-97 requires the treatment team, should it begin medicating a patient pursuant to an order, to conclude that the patient continues to satisfy all four criteria at the appropriate review schedule, which is to occur six months after the ordered treatment begins and annually thereafter. [12] ¶ 42 Those four required findings, like the requirements in Wis. Stat. § 971.17(3)(c), more than adequately address the concern of protecting the individual's liberty interest, while recognizing the State's interest in medicating and treating individuals who are not competent to make their own treatment decisions. Indeed, Wood does not argue otherwise; rather, as noted previously, he focuses on the requirement for a finding of dangerousness and argues that the standards found in AD-11-97 are inadequate. Again, even if we were to assume that due process requires an express finding of dangerousness, the third requirement provides a more than adequate standard. ¶ 43 To satisfy the third requirement, the treatment team is to determine that there is a current risk of harm to self or others if medication [is] not administered. [13] The directive then provides six possible consequences that the treatment team, if it concludes they are likely to occur, must use as a basis for the finding of dangerousness: a. The patient may suffer significant psychological harm, for example[,] mental anguish, pain, suffering, fear, anxiety or desperation, if medication was not administered; b. The patient may cause physical harm to others in the facility if medication was not administered, considering the patient's history of physical violence and treatment history; c. There may be harm to the prospects for successful treatment of the patient's mental condition if medication was not administered, for example, the patient's mental condition may become increasingly resistant to treatment the longer the patient does not take medications; d. The patient may cause self-harm if medication was not administered, considering the patient's history of self-abuse, treatment history and the potential effectiveness of medication in addressing the behavior; e. The patient may suffer significant deterioration to his or her health or safety if medication was not administered, considering the effect of the patient's mental condition on the patient's ability or willingness to receive care that is essential for health or safety; AND/OR f. The patient may cause physical harm to others outside the facility if medication was not administered, considering the patient's history of physical violence, the patient's treatment history, the proximity of the patient's probable release date, the likelihood of adequately treating the patient's mental condition without medications before release, and the adequacy of means available in the community to prevent the patient from causing harm to others. [14] ¶ 44 Wood argues that the standards are facially overbroad and vague in several respects. [15] Essentially, Wood objects to the (1) breadth of general symptoms considered, particularly in consequences a and e; (2) the content of consequence c, which he argues does not relate to a finding of dangerousness; and (3) the permissible consideration of past physical violence in consequences b, d, and f. ¶ 45 We disagree with Wood that the symptoms listed are overbroad. While the symptoms in consequences a and e, listed singly, may be not uncommon symptoms, those paragraphs frame the symptoms as causing a risk of significant psychological harm and significant deterioration to the patient's health and safety. That context, in our view, raises those symptoms to a level beyond those occurring in patients not in need of involuntary medical intervention. Moreover, the content of consequence c, which addresses whether medication is necessary to ensure the future effectiveness of medication and treatment, is related to dangerousness, inasmuch as unsuccessful treatment of the patient's mental illness results in a risk to the patient's safety, as well as the public's, given that the patient will be released eventually from the institution. Finally, past violence is relevant to a finding of current dangerousness. Although we agree with the district court's statement in Enis that when a finding of dangerousness is required, that finding must show present dangerousness, nothing in Harper, Riggins, or Sell precludes a court from considering the individual's past crimes when assessing present dangerousness. Indeed, where a person's past acts of violence were products of mental illness, consideration of the nature and seriousness of those past violent crimes is vital to assessing the level of danger posed when the mental illness is untreated. ¶ 46 In summary, we are satisfied that a finding of dangerousness is not required to order the involuntary medication of an individual committed under Wis. Stat. § 971.17. By that reasoning, Wis. Stat. § 971.17(3)(c) and AD-11-97 cannot be deemed to be facially invalid based on substantive due process requirements. Moreover, even if a finding of dangerousness is required, the directive requires an express finding of dangerousness and the statute implicitly contains the equivalent of an express requirement. Hence, they are not facially invalid.