Turner Reinforces The Need For Assertive Civil Commitment Defense
On September 14, 2020, the Minnesota Court of Appeals issued In the Matter of the Civil Commitment of: Brian James Turner, a published appellate opinion that reinforces that patients in Minnesota subject to civil commitment proceedings (such as a Jarvis hearing) must affirmatively request the district court to appoint a substitute decision-maker before it orders the involuntary administration of neuroleptic medication. If the patient—or their civil commitment defense attorneys or law firm—does not make a request for a substitute decision-maker, Turner clarifies that the district court has no obligation to even consider it.
Mr. Turner—a 26-year-old Minnesotan—was civilly committed to the custody of the Commissioner of the Department of Human Services (DHS) on January 23, 2020. Turner had a history of schizophrenia and two prior civil commitments and, during his most recent release from commitment, stopped taking his medication as prescribed. As a result of subsequent episodes, Turner was again committed to Community Behavioral Health Hospital in Bemidji, Minnesota (CBHH-Bemidji).
Approximately one week after Turner was transferred to Bemidji, his treating physician filed a petition to authorize the involuntary administration of neuroleptic medication. After a Jarvis hearing (a civil commitment evidentiary hearing), the district court issued an order siding with the physician. In the order, the court specifically found that Turner lacked the capacity to gauge whether he should or should not be medicated and, over Turner’s objection, ordered the involuntary administration of up to 5 different neuroleptic medications depending on which medication(s) were more effective.
Turner, through a civil commitment appeal lawyer, appealed to the Minnesota Court of Appeals. On appeal, he argued that the district court should have appointed a substitute decision-maker, especially given the court’s finding that Turner lacked the capacity to gauge his own need for medication. Turner cited Minn. Stat. § 253B.092, subd. 6, which states that a substitute decision-maker will be appointed by the court “[u]pon request of any person, and upon a showing that administration of neuroleptic medications may be recommended and that the person may lack capacity to make decisions regarding the administration of neuroleptic medication.”
Minn. Stat. § 253B.092 generally establishes rules and procedures that govern the administration of neuroleptic medication to patients under civil commitment for being mentally ill and/or suffering from a mental illness. Essentially, treatment providers may recommend the administration of neuroleptic medication, which is a broad descriptor for medications intended to reduce symptoms of psychosis. If the patient lacks capacity or refuses to consent to treatment, however, physicians generally cannot force patients to undergo treatment involuntarily unless they first receive authority from a court. The law presumes that patients have the capacity to make decisions regarding the administration of neuroleptic medication and if the court concludes that an individual patient has capacity, the patient’s wishes regarding neuroleptic medication will generally govern.
However, if the patient lacks capacity (and if the patient did not clearly state what they would choose to do at a point in the past when they did have capacity), the district court may make a determination based up on what a “reasonable person” would do if that person were in the same situation as the patient. If the court finds that a reasonable person would consent to treatment, then the court can order that neuroleptic medications be administered—even over the objection of the patient. Section 253B.092 of the Minnesota statutes outlines what factors are relevant for a judge to consider in making that determination.
That same section of the Minnesota statutes, however, also authorizes the administration of neuroleptic medications without any input from a district court in several other circumstances. This includes situations where a substitute decision-maker appointed by a court consents to the administration of the neuroleptic medication and the patient does not refuse administration of the medication.
In his appeal, Turner relied on that provision. He argued that before seeking a court order authorizing the involuntary administration of neuroleptics, the state and the treating physicians should have pursued the less intrusive method of securing treatment and sought a substitute decision-maker. Depending on the outcome of that proceeding, the state and treating physicians could have pursued the district court for relief.
The Court of Appeals disagreed. First, it held that the relevant statute required Turner to affirmatively request a substitute decision-maker and that, absent that request, the district court had no obligation to appoint one sua sponte. Second, the way in which the relevant statutes were worded, it appeared as though the Minnesota Legislature did not intend for either type of review to be a prerequisite to the other. Rather, they were alternatives. Finally, the appeals court held that interpreting the statute as Turner urged would create a pointless hoop for DHS and the treating physicians to jump through in cases such as Turner’s, where the patient had already obviously and repeatedly objected to receiving treatment. Put another way: Even if a substitute decision-maker had been appointed in Turner’s case, by Minnesota statute that decision-maker could not have overridden Turner’s express refusal.
The Court of Appeals affirmed the district court’s order and, unless Turner can successfully appeal to the Minnesota Supreme Court, he is likely subject to the involuntary administration of neuroleptic medication at least until the expiration of his current civil commitment.
Turner is an important case not only due to the clarity it affords the Minnesota civil commitment procedural statutes, but also because it reinforces the importance of working with knowledgeable civil commitment defense lawyers in Minneapolis, St. Paul, and throughout greater Minnesota. Civil commitment proceedings are serious, and the consequences for failing to adequately defend oneself can be severe. Turner may have benefited from an independent substitute decision-maker. But even more, Turner may have benefited from counsel related to numerous other areas of his defense, including representation in communications with his treating physicians, through investigations and reviews of the applicable records and recommendations, and at the actual Jarvis hearing itself (through which the Court ordered Turner’s third commitment). Wilson Criminal Defense has experience throughout Minnesota in the area of civil commitment and will fight civil commitment on the front end of a case and through on to a full-fledged civil commitment appeal. The firm will ensure that patients’ rights and options are investigated thoroughly, explained clearly, and exercised effectively wherever appropriate.
Read the full opinion here: https://www.mncourts.gov/mncourtsgov/media/Appellate/Court%20of%20Appeals/Standard%20opinions/OPa200523-091420.pdf