Court Opinion

ID: 9390788
Source: CourtListenerOpinion
Date Created: 2023-04-28 17:02:19.32451+00
Date Added: 2024-06-11T17:18:36.835505
License: Public Domain

Notice: This opinion is subject to correction before publication in the PACIFIC REPORTER.
      Readers are requested to bring errors to the attention of the Clerk of the Appellate Courts,
      303 K Street, Anchorage, Alaska 99501, phone (907) 264-0608, fax (907) 264-0878, email
      corrections@akcourts.gov.

               THE SUPREME COURT OF THE STATE OF ALASKA

In the Matter of the Necessity for the             )
Hospitalization of                                 )   Supreme Court Nos. S-17389/17616
                                                   )   (Consolidated)
ABIGAIL B.                                         )
                                                   )   Superior Court No. 3AN-19-00135 PR
                                                   )
                                                   )   OPINION
In the Matter of the Necessity for the             )
Hospitalization of                                 )   No. 7650 – April 28, 2023
                                                   )
JETHRO S.                                          )
                                                   )   Superior Court No. 3KN-19-00129 PR
                                                   )

              Appeal in File No. S-17389 from the Superior Court of the
              State of Alaska, Third Judicial District, Anchorage, Andrew
              Guidi, Judge. Appeal in File No. S-17616 from the Superior
              Court of the State of Alaska, Third Judicial District, Kenai,
              Lance Joanis, Judge.

              Appearances: George W.P. Madeira, Assistant Public
              Defender, and Samantha Cherot, Public Defender,
              Anchorage, for Abigail B. and Jethro S. Laura Wolff,
              Assistant Attorney General, Anchorage, and Treg R. Taylor,
              Attorney General, Juneau, for State of Alaska.

              Before: Winfree, Chief Justice, Maassen, Carney, and
              Henderson, Justices. [Borghesan, Justice, not participating.]

              HENDERSON, Justice.
I.     INTRODUCTION
              Two individuals were detained at local hospitals after they suffered
psychiatric emergencies. The superior court orders authorizing the detentions required
each individual to be immediately transported to an available bed at an evaluation
facility. But there were no beds available, so neither individual was immediately
transported. After holding review hearings at the individuals’ requests, the superior
court in each case authorized continued detention. The individuals remained detained
in hospitals until they were transported to evaluation facilities. They appeal the detention
orders, arguing that their prolonged pre-evaluation detentions violated their substantive
due process rights. Applying our recent decision in In re Hospitalization of Mabel B.,1
we agree that the individuals’ substantive due process rights were violated because the
nature and duration of their detentions were not reasonably related to the purpose of
facilitating immediate transportation for evaluation.
II.    FACTS AND PROCEEDINGS
       A.     Statutory Framework
              Alaska law provides procedures for certain individuals with mental illness
or grave disability to undergo involuntary commitment.2 Upon petition and a superior
court’s determination that there is probable cause to believe an individual is mentally ill
and, as a result of that mental illness, is gravely disabled or likely to cause serious harm
to self or others, the court may order that the individual be transported to an evaluation
facility for further examination and evaluation of whether the person meets commitment

       1
              485 P.3d 1018 (Alaska 2021).
       2
              485 P.3d at 1019-20; see generally AS 47.30.700-.815 (detailing
involuntary commitment procedures). We note that the legislature amended these
statutes during the pendency of this case. See SLA 2022, ch. 41, eff. Oct. 13, 2022.
These amendments do not affect our analysis.

                                            -2-                                       7650
criteria.3 In emergent circumstances, when a peace officer or particular type of licensed
health professional has probable cause to believe a person is gravely disabled or mentally
ill and likely to cause serious harm of an especially immediate nature to self or others,
that person may be placed in protective custody pending further evaluation.4 “When a
facility receives a proper order for evaluation, it shall accept the order and the respondent
for an evaluation period not to exceed 72 hours,” excluding weekends and holidays.5
Although the “statutes do not explicitly create any time limits between the ex parte order

       3
               See In re Mabel B., 485 P.3d at 1019-20. As outlined in In re Mabel B., an
involuntary commitment may begin with any adult’s petition to superior court with
reasonable belief that a person “present[s] a likelihood of serious harm to self or others
or is gravely disabled as a result of mental illness.” Id. at 1019 (quoting AS 47.30.700).
If the court then finds probable cause to support that reasonable belief, it may issue an
ex parte order and direct a peace officer to transport the person “to the nearest
appropriate facility for emergency examination or treatment.” Id. (quoting
AS 47.30.700(a)). Alternatively, an involuntary commitment may begin with an
emergency detention for evaluation. Id. at 1019-20; AS 47.30.705. A peace officer or
certain licensed health professionals with “probable cause to believe that a person is
gravely disabled or is suffering from mental illness and is likely to cause serious harm
to self or others” may take that person into protective custody, transport the person to an
appropriate evaluation facility, and apply for a mental health examination.
AS 47.30.705(a). In such a case, any likely harm to self or others must be “of such an
immediate nature” that safety concerns prevent initiating involuntary commitment via
a superior court petition under AS 47.30.700. See id.
       4
              See In re Mabel B. 485 P.3d at 1019-20; AS 47.30.705.
       5
             AS 47.30.715 (requiring evaluation facility to “accept the order and the
respondent for an evaluation period not to exceed 72 hours”); AS 47.30.805(a)(1)
(excluding weekends and holidays from 72-hour computation); In re Hospitalization of
Gabriel C., 324 P.3d 835, 837-38 (Alaska 2014) (holding that 72-hour period begins
when individual arrives at evaluation facility).

                                            -3-                                        7650
and transport to the facility,”6 they nonetheless “evidence a legislative intent that the
respondent who is subject to an emergency ex parte order must be transported
immediately to the nearest evaluation facility.”7 Due to facility capacity issues, however,
individuals like the respondents in this case have at times been detained for lengthy
periods while awaiting evaluation.8
       B.     Abigail’s Pre-Evaluation Detention
              On January 19, 2019, Abigail9 was taken to the emergency room at
Providence Kodiak Island Medical Center after her husband called the State Troopers to
report she had attempted suicide. She was escorted by a Kodiak police officer, who sent
the court notice of Abigail’s emergency pre-evaluation detention indicating his belief that
Abigail was mentally ill and that there was probable cause she was likely to cause serious
self-harm based on her statements that “she wanted to kill herself” after she “admitted
taking approximately 20 pills” over the prescribed amount.
              When Abigail arrived at the hospital she tried to harm herself, including by
pulling out her own hair, and was aggressive toward hospital staff. Abigail presented
“right below” the “highest risk” level when she was admitted. The Kodiak hospital staff
restrained her physically and chemically, including temporary use of four-point physical
restraints and a shot of the powerful anti-psychotic drug Haldol, which can continue
having effects for up to a week and a half. The hospital would not let her leave without

       6
              In re Mabel B., 485 P.3d at 1020.
       7
              In re Gabriel C., 324 P.3d at 838.
       8
             See In re Mabel B., 485 P.3d at 1020-23 (documenting detentions of
respondents awaiting mental health evaluations for more than two weeks).
       9
              We use pseudonyms to protect the parties’ privacy.

                                            -4-                                      7650
a court order; had she attempted to leave, hospital security would have detained her or
called the police to detain her in the hospital or in jail.
              A social worker at the hospital petitioned the superior court for an ex parte
order authorizing Abigail’s hospitalization for evaluation. The petition alleged that
Abigail was mentally ill because she had tried to commit suicide by ingesting a bottle of
prescription acetaminophen-codeine while drinking three large beers. It also explained
that Abigail told paramedics she “wanted to kill herself” and told an emergency room
doctor that she “want[ed] [t]o die.” A master recommended granting the order for
hospitalization at the first available facility, and the superior court approved the master’s
recommendation.
              Despite the superior court’s order that Abigail be delivered “immediate[ly]”
to the “first available bed” at an evaluation facility, she remained detained at the Kodiak
hospital because there were no available beds at any evaluation facilities. Nine days after
Abigail was initially detained, she filed an unopposed motion for a review hearing and
argued that her detention was no longer warranted.
              The superior court held the review hearing on January 30 — 11 days after
Abigail’s initial detention. The State presented a counselor from the Kodiak hospital as
its sole witness. The counselor had interviewed Abigail on four separate days during her
detention, including the day of the hearing. He testified that, in his opinion, Abigail still
met the criteria for emergency hospitalization and continued to be a danger to herself.
Relying on his review of Abigail’s medical records and information from other
clinicians, the counselor explained that Abigail had a long history of sudden mental
health crises requiring restraint and the administration of medication. He also stated that
Abigail had continued to express suicidal ideation as recently as the morning of the
hearing, but he did not believe she had a present plan to follow through.

                                             -5-                                       7650
              The counselor further testified that Abigail was doing “a lot better” since
she was admitted; she had “significantly calmed down” and did not have “any other
incidents requiring restraints.” He attributed most of her improvement to the Haldol
injection administered soon after she arrived at the hospital; he noted that the effects last
“sometimes a week to a week and a half” and she had not yet needed another dose. But
“when that medication wears off, [a person] . . . could become psychotic very quickly.”
He assessed Abigail as “fairly pleasant” and explained that she had “been writing down
some coping skills and doing some coloring,” but she also “sometimes start[ed] to cry.”
In his opinion releasing Abigail from the hospital was “moderate to high risk” and “it’s
best to get someone set up on medication and have them stable and observed for a period
of time” to ensure the medication is working.
              Regarding the availability of evaluation facilities, the counselor explained
that Abigail was third on the wait list at Alaska Psychiatric Institute (API) in Anchorage
but Bartlett Regional Hospital in Juneau could accept her as soon as the Kodiak hospital
could “set up transportation[,] which usually takes a day or two.” He also testified that
the Kodiak hospital staff had tried to place Abigail at other facilities in Fairbanks and
Anchorage, but those facilities could not accept her.
              Abigail then testified on her own behalf. She said she felt that she had
stabilized since she first arrived at the hospital; she had identified triggers for negative
thoughts and written down those triggers, her post-discharge goals, and different coping
skills such as breathing, going for a walk, stretching, and yoga. Abigail agreed there was
a valid concern about self-harm when she was initially detained, but she stated that she
no longer had any intention of harming herself and that “today is a definite change from
when I came in.”
              Both Abigail and the counselor also testified that Abigail was taking other
medications for her condition in addition to the initial Haldol shot: Abilify, an anti­

                                            -6-                                        7650
psychotic; Prozac, an anti-depressant; and Ativan, an anxiety medication. According to
Abigail, she had not been prescribed Abilify before she was detained at the Kodiak
hospital. Abigail explained that after discharge, she planned to return to her family in
Akiak where she could obtain prescription refills and access outpatient therapy.
              Once testimony and closing arguments were completed, the judge issued
an oral ruling on the record. The court attributed Abigail’s improvement primarily to the
Haldol injection, which would soon wear off, and noted that “there’s been no testimony
at this point that [the] medications are sufficient to prevent a relapse of the condition that
brought [Abigail] back to the hospital.” Additionally, the court found that there was no
evidence to “create some confidence” that the medications and coping mechanisms
combined would prevent Abigail from “immediately . . . spiral[ing] down into self
harm.” And the court noted that Abigail had expressed suicidal ideation “as recently as
this morning.” Although Abigail had improved, the court determined that her condition
had not yet “reached a period of stability.” The court thus concluded that there was
probable cause to believe that Abigail’s condition would “re-emerge” if she were
released and found that there was no less restrictive alternative than detention at the
Kodiak hospital. The court also stated that it was “sufficient to meet constitutional
requirements for due process to have this review hearing and to check the status of the
evidence to make sure that it at least meets the threshold for . . . the initial detention.”
              The court then scheduled another review hearing 48 hours later “to see
whether there’s been any evidence of marked improvement, marked deterioration, or
whether the State has had an opportunity to . . . initiate the 72-hour evaluation.” On
February 1, two days after the initial review hearing and 13 days after the State initially
detained Abigail, she was transported to Bartlett Regional Hospital in Juneau for an
evaluation. Bartlett released Abigail on February 3 after staff determined she did not
meet the criteria for involuntary commitment.

                                             -7-                                        7650
      C.      Jethro’s Pre-Evaluation Detention
              Jethro brought himself to the emergency room at Central Peninsula Hospital
in Soldotna on May 7, 2019, to seek help for an acute episode of schizophrenia. Jethro
was homeless at the time. He was struggling with psychosis and a significant traumatic
brain disorder, and had lost access to medications that helped stabilize him. Jethro had
been hospitalized at the Soldotna hospital on multiple previous occasions due to these
conditions.
              A physician at the Soldotna hospital sent the court notice of Jethro’s pre­
evaluation detention, indicating the physician’s belief that Jethro was mentally ill and
there was probable cause Jethro would likely seriously harm himself or others because
Jethro was “suicidal, potentially homicidal.” A counselor then filed a petition to
hospitalize him for evaluation. The counselor believed Jethro to be mentally ill and “in
danger of physical harm” to himself “if he is not placed in a protective environment.”
The counselor noted that Jethro had “command hallucinations tell[ing] him to kill
himself” and a “persecutory voice in his head” telling him to harm himself or others, “for
example by stealing a car and running it into a wall.” The petition also recounted
Jethro’s reports that he was “seeing people with guns hiding in the trees placed there by
the government to watch his every move.”
              That same day, a master reviewed the petition and recommended that it be
granted based on probable cause findings that Jethro was mentally ill and gravely
disabled. The master’s recommendation directed the State to file daily status reports if
Jethro could not be transported to an evaluation facility within 24 hours. The superior

                                           -8-                                      7650
court approved the master’s recommendation and ordered an attorney appointed for
Jethro the next day.10 However, Jethro’s last name was spelled incorrectly on the order.
              Jethro remained detained at the Soldotna hospital due to lack of evaluation
facility capacity, despite the superior court’s order that he be delivered “immediate[ly]”
to such a facility. Thirteen days after Jethro was initially detained, he filed a partially
unopposed motion for a review hearing and argued that his detention was no longer
warranted.
              A master held a review hearing on May 24 — 17 days after Jethro’s initial
detention. The State presented a social worker from the Soldotna hospital as its sole
witness. The social worker had interviewed Jethro multiple times during his current stay
and was familiar with some of his prior hospitalizations. She believed that Jethro still
needed to be evaluated at API because the Soldotna hospital providers and his outpatient
providers would not be prepared to administer the necessary medications. And Jethro
had not yet seen a psychiatrist or psychiatric nurse practitioner, so he had not yet been
prescribed the appropriate doses of his medications. The social worker explained that
there was “a huge deficit in psychiatric providers” and no psychiatrist on the
Kenai Peninsula; the only psychiatrist who the social worker was familiar with in the
area worked with the Alaska Native Medical Center and came only “once a month for
a day.” She also testified that the hospital had not tried to arrange a visit with a
psychiatric provider through telemedicine because it didn’t “have that ability,” which
was “actually embarrassing for [it] at this point.”
              Especially given Jethro’s history of decompensation without medication
and the fact that he was homeless, the social worker believed discharging him might lead

       10
             See AS 47.30.700(a) (establishing initial involuntary commitment
procedures, including mandatory appointment of counsel for respondent).

                                            -9-                                      7650
to self-harm or an inability to care for himself. She emphasized that when he
decompensates “[h]e tries very, very, very hard not to harm himself or others, but he gets
to the place where that’s a serious danger”; however, she was not sure how long it would
take for Jethro to decompensate if released. On cross-examination the social worker
explained that she did not believe Jethro had hurt himself or others while at the hospital,
nor had he expressed any current intent to do so, but he had been self-harming
“significant[ly]” immediately prior to his arrival. She also testified that Jethro was taking
care of his activities of daily living with help from staff at the hospital. The social
worker felt that she had a “pretty good rapport” with Jethro and thought he was “pretty
honest . . . about his struggles.”
              Jethro then made a short statement, explaining that while it was “a little bit
out of [his] league,” he didn’t believe it was necessary for him “to be at API to be
evaluated by a psychiatrist when” his primary care provider could “reasonably stabilize
[his] medication.”
              After testimony and closing arguments, the master made findings on record,
recommending that the court uphold the initial hospitalization order. The master began
by finding that Jethro already would have been transported to API, but for the
typographical error misspelling Jethro’s last name in the order authorizing hospitalization
for evaluation. The master then explained that while Jethro “certainly ha[d] fundamental
liberty interests at stake,” the State also had interests in protecting both him and the
community. The court held that Jethro continued to meet the detention criteria, because
Jethro’s recent stabilization was temporary and due to his hospitalization. The court
found that Jethro was “gravely disabled based on . . . his medical diagnoses and the
statements that he made when he was interviewed at [the hospital]. We need the
evaluation so that he can be treated and safely be released.”

                                            -10-                                       7650
             The master found the evidence presented was sufficient to meet both the
probable cause standard for ex parte proceedings,11 and the clear and convincing
evidence standard required for a 30-day commitment hearing.12 The master followed his
oral ruling with written recommendations, which were subsequently approved by the
superior court.
             Jethro was transported to API later that day. After the 72-hour evaluation
period expired on May 29, Jethro voluntarily admitted himself to API. He was
discharged the following day with a small supply of medication, a prescription for a
month of medication, and a follow-up appointment in Kenai.
       D.    Appeal
             Abigail and Jethro appeal the superior court orders permitting their
continued pre-evaluation detentions after review hearings. Both cases were stayed
pending our resolution of Mabel B. After the stay was lifted we consolidated the cases
“for the purposes of briefing and decision.”
III.   STANDARD OF REVIEW
             “We apply our independent judgment to the interpretation of the Alaska
Constitution and the mental health commitment statutes and will adopt the rule of law
that is most persuasive in light of reason, precedent, and policy.”13 We review factual

       11
             AS 47.30.700(a).
       12
             AS 47.30.735(c).
       13
              In re Hospitalization of Mabel B., 485 P.3d 1018, 1024 (Alaska 2021) (first
quoting In re Hospitalization of Gabriel C., 324 P.3d 835, 837 (Alaska 2014); and then
quoting In re Hospitalization of Naomi B., 435 P.3d 918, 924 (Alaska 2019)).

                                          -11-                                     7650
findings “for clear error and will reverse only if we have a definite and firm conviction
that a mistake has been made.”14
IV.   DISCUSSION
             Abigail and Jethro argue that the lengthy delays between their pre­
evaluation detentions and their transportation to an evaluation facility violated their
substantive due process rights under the United States and Alaska Constitutions.15 They
contend their substantive due process rights were violated because the nature and
duration of their pre-evaluation detentions were not reasonably related to the purpose of
immediately transporting them to an evaluation facility. Additionally, Abigail and Jethro
encourage us to adopt a presumption “that a pre-evaluation detention of seven days . . .
violates substantive due process.” Finally, they argue that we should “direct trial courts
to use their inherent authority to impose sanctions for contempt when the state fails to
perform a timely emergency evaluation.”
      A.     In re Hospitalization of Mabel B.
             The circumstances of the State’s detentions of Abigail and Jethro are similar
to those addressed in our 2021 In re Hospitalization of Mabel B. decision.16 In that
consolidated case, like this one, the two respondents were detained while awaiting
transportation for mental health evaluations, and they argued that the lengthy detentions
violated their substantive due process rights.17 The respondents’ arguments in this appeal
thus focus on the legal and factual similarities between the two cases.

      14
             In re Hospitalization of Mark V., 501 P.3d 228, 234 (Alaska 2021) (quoting
In re Hospitalization of Luciano G., 450 P.3d 1258, 1262 (Alaska 2019)).
      15
             U.S. Const. amend. XIV, § 1; Alaska Const. art. I, § 7.
      16
             In re Mabel B., 485 P.3d at 1020-23.
      17
             Id.

                                          -12-                                      7650
              Both respondents in Mabel B. were brought to local hospitals after they
suffered psychiatric emergencies.18 In each instance hospital employees petitioned the
superior court for an order authorizing hospitalization for evaluation, and the court
granted the order.19 Each order required the State to “arrange for immediate delivery”
of the respondent to an evaluation facility.20 But the respondents were not immediately
transported for evaluation due to the lack of facility capacity, and they remained detained
in the hospitals while awaiting mental health evaluations.21
              One respondent requested a review hearing 14 days after the order
authorizing hospitalization for evaluation was issued.22 The superior court held the
requested hearing two days later to address whether the respondent’s detention was still
warranted.23 The respondent suffered from dementia, and a consulting psychologist at
the hospital testified that while the respondent’s condition had not changed, treatment at
API was not likely to “be fruitful.”24 Despite expressing “real misgivings” about the
respondent’s “predicament,” the court permitted the respondent’s continued detention.25

       18
              Id. at 1019, 1021-22.
       19
              Id.
       20
              Id.
       21
              Id. at 1021-23.
       22
              Id. at 1021.
       23
              Id.
       24
              Id.
       25
              Id. at 1021-22.

                                           -13-                                      7650
The respondent was transported to API for evaluation that day and was released four
days later after API staff determined she no longer met the commitment criteria.26
               The other respondent in Mabel B. requested a review hearing six days after
the order authorizing hospitalization was issued, and the superior court held the hearing
two days later.27 Hospital staff testified that they believed the respondent still met the
criteria to be held for an evaluation, despite acknowledging that they “d[id] not have the
expertise . . . to make assessments and judgments in complex cases” like the
respondent’s.28 Staff also noted that the respondent had not followed through on
outpatient mental health treatment in the past.29 The respondent then testified, explaining
that “she had her health issues ‘under control’ and had no intention of hurting herself.”30
The court was “disheartened” because no referrals had been made to potentially available
evaluation facilities, but it nonetheless concluded that the respondent’s detention was still
necessary.31
               Subsequently, the respondent requested a second review hearing, which the
court held seven days after the first.32 A crisis clinician testified that the respondent was
still a danger to herself, and a social worker testified that she had contacted two other

       26
               Id. at 1022.
       27
               Id.
       28
               Id. (alterations in original).
       29
               Id.
       30
               Id.
       31
               Id. at 1023.
       32
               Id.

                                                -14-                                   7650
evaluation facilities but neither had any beds available.33 The respondent then testified
once more, “explaining that she was no longer suicidal and that she had support systems
in place upon discharge.”34 The court again permitted the respondent’s continued
detention, despite expressing concerns about the delayed evaluation.35 The respondent
was transported to API for evaluation three days later.36 API staff petitioned for a 30-day
commitment, but the respondent was discharged before the commitment hearing was
held.37
               Both respondents appealed the State’s involuntary pre-evaluation
detentions, contending that “their substantive due process rights were violated when they
were held in hospitals for over two weeks before being admitted to API for evaluation.”38
We first held that under the United States and Alaska Constitutions, substantive due
process “at the least . . . requires that the nature and duration of commitment bear some
reasonable relation to the purpose for which the individual is committed.”39 We also
explicitly “decline[d] to set an exact time at which a pre-evaluation detention becomes

          33
               Id.
          34
               Id.
          35
               Id.
          36
               Id.
          37
               Id.
          38
               Id. at 1023, 1025.
          39
            Id. at 1025 (alteration in original) (quoting Jackson v. Indiana, 406 U.S.
715, 738 (1972)).

                                           -15-                                      7650
so long that it violates due process”40 because asserted due process violations are “to be
tested by an appraisal of the totality of facts in a given case.”41
              Turning to the purpose of the detentions, we explained that the respondents
“were detained solely for the purpose of ‘immediate delivery’ to an evaluation facility
to determine whether they met the standards for involuntary commitment to a treatment
facility.”42 Despite this sole purpose for the orders, the State used them “to detain the
respondents for almost six times as long as the evaluation period” and “nearly as long
as the commitment that could be ordered at the end of the evaluation.”43 “The State’s
only explanation for the length of respondents’ pre-evaluation detentions was API’s lack
of capacity, which [wa]s an insufficient justification in this case.”44 Evaluating “the
totality of facts in [each] given case,” we concluded “there was no reasonable relation
between the limited purpose of the evaluation orders and the extended duration of the
respondents’ confinements.”45 Because the State’s “unreasonably lengthy detentions of
[respondents] violated their substantive due process rights,” we vacated the orders
permitting their continued detention.46

       40
              Id. at 1026.
       41
              Id. (quoting Cnty. of Sacramento v. Lewis, 523 U.S. 833, 850 (1998)).
       42
              Id. (citing AS 47.30.705-.730).
       43
              Id.
       44
              Id.
       45
              Id. (quoting Lewis, 523 U.S. at 850).
       46
              Id. The respondents also argued that under the Alaska Constitution, their
detentions needed to “be justified by a compelling state interest and no less restrictive
alternative”; we did not decide that question “because we ultimately conclude[d] that the
                                                                           (continued...)

                                            -16-                                    7650
      B.      Abigail’s And Jethro’s Detentions Violated Their Substantive Due
              Process Rights.
              Abigail and Jethro assert that, as in Mabel B., the nature and duration of
their detentions were not reasonably related to the limited purpose of facilitating
immediate transportation for evaluation. The State responds by arguing that we should
recognize broader purposes for pre-evaluation detention — despite Mabel B.’s
suggestion to the contrary — and we should uphold the detentions in this case because
their nature and duration were reasonably related to those broader purposes. We
maintain our prior holding that the purpose for pre-evaluation detention in this context
is limited to facilitating immediate transport to an evaluation facility, and we conclude
that the State’s detentions of Abigail and Jethro violated their substantive due process
rights because the restrictive nature and long duration of their respective detentions were
not reasonably related to the limited purpose of transporting them for emergency
evaluation.
              1.     The sole purpose of pre-evaluation detention is to facilitate
                     immediate delivery to an evaluation facility.
              Abigail and Jethro emphasize Mabel B.’s determination that the respondents
in that case were detained “solely for the purpose of ‘immediate delivery’ to an
evaluation facility,”47 and contend that nothing meaningfully distinguishes the purpose
of their respective detentions from those at issue in Mabel B. In response, the State does
not argue that Mabel B. should be overruled but instead maintains that it is an “outlier”
and that, although we determined the sole allowable purpose of pre-evaluation detention

      46
             (...continued)
confinement in th[at] case fail[ed] to satisfy the less demanding ‘reasonable relation’
standard.” Id. at 1025 n.49. Abigail and Jethro did not raise that argument in this case.

      47
              Id. at 1026.

                                           -17-                                      7650
in that case, broader purposes are relevant in these cases. These broader purposes,
according to the State, include “protecting vulnerable people from harming themselves,
protecting society from people who are dangerous to others, and providing treatment for
people who are mentally ill and in need of care.” Notably, in Mabel B. the State argued
that functionally identical purposes justified the detentions in those matters and we
rejected that argument and instead held that the sole allowable purpose of the detentions
was “ ‘immediate delivery’ to an evaluation facility.”48
             In the cases currently before us, the State contends we should evaluate the
purpose of pre-evaluation detention differently because, in its view, detention is “more
compelling” when the evidence of grave disability or danger to self or others meets at
least the probable cause standard. But we did not assess this aspect of the respondents’
detentions in Mabel B. when we determined their purpose; we instead referenced only
the “legislative intent that the respondent . . . must be transported immediately to the
nearest evaluation facility.”49 Abigail and Jethro correctly note that broadening the
purpose of pre-evaluation detention beyond immediate transport would contradict
Mabel B. Abigail and Jethro also point out that “[i]f a detention order serves purposes
other than immediate transport for evaluation, it could extend indefinitely and no longer
represent a preliminary determination for which the low threshold of probable cause is
appropriate.” The broader purposes identified by the State are undoubtedly relevant to
the involuntary commitment framework as a whole. And we agree that respondents who
have been detained may receive interim stabilizing care while awaiting transportation.
But until a respondent receives an ordered evaluation, the parties are without important

      48
             Id.
      49
             Id. (quoting In re Hospitalization of Gabriel C., 324 P.3d 835, 838 (Alaska
2014)).

                                          -18-                                     7650
information about the respondent’s condition and appropriate treatment, and unable to
advance toward commitment proceedings meant to address the broader interests
discussed by the State. Moreover, the massive curtailment of liberty at stake in the
context of involuntary commitment makes preserving procedural protections at the pre­
evaluation stage all the more important.50 Therefore we agree with Abigail and Jethro
that, as we recognized in Mabel B., the sole purpose of pre-evaluation detention is
limited to “ ‘immediate delivery’ to an evaluation facility.”51 We decline to revisit that
determination.
              2.     The nature and duration of Abigail’s and Jethro’s detentions
                     were not reasonably related to the purpose of immediate
                     delivery for evaluation.
              With the sole purpose of pre-evaluation detention in mind, we turn to
examine both the nature and the duration of Abigail’s and Jethro’s respective detentions.
              Looking to the nature of their detentions, we note that, as in Mabel B., both
Abigail and Jethro were detained in hospital settings where hospital staff provided for
their immediate needs, including administering their medications and providing
counseling, and in Abigail’s case, restraining her as necessary to prevent harm. Their
detentions were involuntary. Although Jethro initially brought himself to the Soldotna

       50
              In re Vern H., 486 P.3d 1123, 1129 (Alaska 2021).
       51
              In re Mabel B., 485 P.3d at 1026 (citing AS 47.30.705-.730). As a practical
matter, we recognize severe weather or other events or conditions may delay safe
transportation to an evaluation facility, particularly for respondents in more remote areas
of Alaska. See, e.g., In re Hospitalization of Stephen O., 314 P.3d 1185, 1187-88
(Alaska 2013) (involving respondent who remained in Haines jail for seven days
awaiting transportation to Juneau hospital for emergency psychiatric evaluation). A
weather-related delay or a natural disaster might lead to a longer detention duration, yet
continue to reasonably relate to the purpose of immediate transportation for evaluation.
However, those circumstances were not raised here; rather, the reason for the delay of
Abigail’s and Jethro’s transportation was the evaluation facilities’ lack of capacity.

                                           -19-                                      7650
hospital, both Abigail and Jethro were ultimately held involuntarily due to their
respective conditions and due to the lack of available space in any facility that could
perform the required evaluation of their mental health. According to their hospital
treatment providers, both Abigail and Jethro continued to meet the probable cause
standard for requiring evaluation at a qualified facility. The Kodiak hospital counselor
testified that Abigail continued to be at risk for self-harm and required further evaluation.
Similarly, the Soldotna hospital social worker who worked with Jethro believed he still
needed to be evaluated at a qualified facility and that discharging him might lead to
severe self-harm and place him at risk given his inability to care for himself. Neither
hospital, however, could perform the full evaluation required to proceed further with
involuntary commitment, and neither could provide treatment that was informed by a full
evaluation. Abigail and Jethro nevertheless continued to experience severe curtailment
of their liberties.
               Looking next to the duration of the pre-evaluation detentions, Abigail was
detained due to lack of capacity in evaluation facilities for 11 days before her review
hearing and 13 days before her transportation for evaluation, while Jethro was detained
prior to transportation for 17 days, 16 of which were due to lack of evaluation facility
capacity. Abigail’s pre-evaluation detention was slightly shorter than the detentions in
Mabel B.,52 but it was about twice as long as the maximum 6-day length of the evaluation

       52
               See In re Mabel B., 485 P.3d at 1021-23.

                                            -20-                                       7650
period that begins once the respondent arrives at the evaluation facility.53 Jethro’s pre­
evaluation detention, on the other hand, was longer than both detentions in Mabel B.54
             Evaluating “the totality of the facts,”55 we conclude that the State’s
detention of Abigail and Jethro violated their substantive due process rights. Both
detentions were protracted over many days. Both detentions were prolonged purely due
to lack of capacity in an evaluation facility. Although both respondents received limited
treatment while detained, that treatment took place in hospitals that could not meet the
respondents’ continued needs for emergency evaluation. We therefore hold that the
nature and duration of Abigail’s and Jethro’s detentions did not reasonably relate to the
purpose of immediate transportation to an evaluation facility.
             In the alternative, the State asserts that the lengthy delay in transporting
Jethro for evaluation was harmless because the superior court found that he met the
detention criteria by clear and convincing evidence, and he ultimately voluntarily
admitted himself to API. We disagree. A review hearing during pre-evaluation
detention is not the same as a 30-day involuntary commitment hearing.               Most
importantly, we have repeatedly emphasized that commitments entail a “massive
curtailment of liberty.”56 At a review hearing the respondent has not yet obtained a full

      53
             See AS 47.30.715 (defining 72-hour evaluation period); AS 47.30.805(a)(1)
(excluding holidays and weekends from 72-hour calculation).
      54
             See In re Mabel B., 485 P.3d at 1021-23, 1026.
      55
             Id. at 1026.
      56
              See, e.g., In re Hospitalization of Gabriel C., 324 P.3d 835, 839 (Alaska
2014); In re Stephen O., 314 P.3d at 1193; see also In re Vern H., 486 P.3d 1123, 1129­
30 (Alaska 2021) (distinguishing between pre-evaluation detention and commitment
hearing based on “several procedural protections” protecting liberty interest at pre­
evaluation detention stage).

                                          -21-                                      7650
mental health evaluation, so the court and the parties lack crucial evidence necessary to
evaluate a respondent for 30-day commitment. Moreover, Jethro only remained at API
for one day after he was voluntarily admitted, so had he been provided a timely
evaluation, his overall detention period may have been significantly shorter. The delay
in Jethro’s evaluation was not obviated by the court’s findings under the clear and
convincing standard or by Jethro’s eventual voluntary admission to API.
      C.     We Decline To Adopt A Presumption That Any Specific Pre-
             Evaluation Detention Duration Violates Substantive Due Process.
             Abigail and Jethro ask us to depart from Mabel B. and hold “that a pre­
evaluation detention of seven days presumptively violates substantive due process,”
instead of evaluating the totality of facts in each case. They suggest that a presumption
would “promote uniformity in addressing” the systemic issues of prolonged detention
and that a seven-day period would be consistent with our precedent. While Abigail and
Jethro acknowledge we declined to set a length of time at which a pre-evaluation
detention would become unconstitutionally long in Mabel B., they contend we should
establish a presumption with a set length of time in this case because their “appeals
demonstrate the persistence of” systemic evaluation delays. The State urges us not to
adopt a presumption, asserting that “[a] presumption is not only constitutionally
inappropriate, but it is also unnecessary as a practical matter” because “courts are
successfully evaluating the circumstances of each case and concluding that some pre­
evaluation detentions violate due process.”
             On the record before us, we are not convinced that it is necessary to
establish a presumption. Because the detentions here occurred almost two years before
we decided Mabel B., these appeals on their own do not indicate that Mabel B.’s
approach of requiring “an appraisal of the totality of facts in a given case” is

                                          -22-                                     7650
unworkable.57 At oral argument Abigail and Jethro cited data collected during a separate
lawsuit against the State regarding evaluation delays, but that lawsuit was settled in 2020,
again prior to our decision in Mabel B.58 They also pointed out that API’s wait list
continues to be somewhat lengthy, suggesting that systemic evaluation delays may still
occur. However, the record is devoid of evidence that trial courts, following our decision
in Mabel B., are not appropriately evaluating the circumstances of each case when
evaluation delays happen.
              Further, even if we were inclined to adopt a presumption, the record before
us is insufficient to determine what amount of delay should be presumed to violate
substantive due process or under what circumstances a presumption should apply.59 We
therefore continue to assess alleged substantive due process violations “by an appraisal
of the totality of facts in a given case.”60
       D.     We Decline To Require That Trial Courts Impose Particular Sanctions
              Against The State.
              Abigail and Jethro further argue that we should “direct trial courts to use
their inherent authority to impose sanctions for contempt when the State fails to perform
a timely emergency evaluation.” They specifically contend we should “direct trial courts
to order . . . a daily fine against the state of $500 per individual respondent still detained

       57
            In re Mabel B., 485 P.3d at 1026 (quoting Cnty. of Sacramento v. Lewis,
523 U.S. 833, 850(1998)).
       58
           See id. at 1020 n.15; Disability Law Ctr. of Alaska, Inc. v. State,
No. 3AN-18-09814 CI (Alaska Super., Aug. 27, 2020).
       59
             Accord Trueblood v. Wash. Dep’t. of Soc. & Health Servs., 822 F.3d 1037,
1045-46 (9th Cir. 2016) (holding that any deadline for pretrial competency evaluations
established by the district court should be based upon constitutional reasonableness
standards and comparable state policy, in addition to what is feasible and achievable).
       60
              In re Mabel B., 485 P.3d at 1026 (quoting Lewis, 523 U.S. at 850).

                                               -23-                                     7650
awaiting emergency evaluation . . . seven days after the ex parte order issues,” and they
suggest that the fines should be “held for the benefit of class members and for the
development of additional resources for emergency evaluations.” The State disagrees,
urging us to reject the “request to transfer . . . the legislature’s power of the purse [to the
courts] in the guise of court fees.”
              Abigail and Jethro rely primarily on Trueblood v. Washington State
Department of Social & Health Services61 to support their argument. That case was a
class action in which a federal district court required Washington State to provide
restoration services within seven days to jailed class members who were found
incompetent to stand trial in their criminal cases.62 When the State failed to comply with
the order, the court began issuing fines “for the benefit of class members.”63 This is not
a class action, so Trueblood’s procedural posture bears little resemblance to this case.
And we are not persuaded on this record that we should direct trial courts to order
particular fines in future cases.
              As Abigail and Jethro note, Alaska’s trial courts possess the power to
impose sanctions for contempt under certain circumstances.                     For example,
AS 09.50.010(5) provides that “disobedience of a lawful . . . order . . . of the court” can
constitute contempt. Alaska Civil Rule 90 sets forth the procedure to be followed: In
general, “upon a proper showing on ex parte motion supported by affidavits, the court
shall [as one option] order the accused party to show cause . . . why the accused party

         61
              822 F.3d 1037.
         62
              No. 2:14-cv-01178-MJP, 2016 WL 3632486, at *1-2 (W.D. Wash. July 7,
2016).
         63
              Id. at *1, *9.

                                             -24­                                        7650
should not be punished for the alleged contempt.”64 Neither Abigail nor Jethro requested
contempt sanctions under Rule 90 in the trial court, so we express no view on whether
sanctions could or should have been imposed in these cases.
V.    CONCLUSION
             We VACATE the superior court orders authorizing the State’s continued
pre-evaluation detention of Abigail and Jethro following their review hearings.

      64
             Alaska R. Civ. P. 90(b).

                                         -25-                                     7650