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You can search the entire site. or go to the recent opinions, or the chronological or subject indices. In Re Hospitalization of Naomi B. (1/11/2019) sp-7328

In Re Hospitalization of Naomi B. (1/11/2019) sp-7328

           Notice:   This opinion is subject to correction before publication in the P                     ACIFIC  REPORTER.  

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                       THE SUPREME COURT OF THE STATE OF ALASKA                                        



In  the  Matter  of  the  Necessity                                   )  

for  the  Hospitalization  of                                         )     Supreme  Court  Nos.  S-15859/16467  

                                                                      )     (Consolidated)  

                

NAOMI B.                                                              )  

                                                                                                                                        

                                                                      )     Superior Court No. 3AN-15-00204 PR  

                                                                      )  

                                                                                                 

                                                                      )     O P I N I O N  

                                                                      )  

                                  

In the Matter of the Necessity                                                                                      

                                                                      )     No. 7328 - January 11, 2019  

                                       

for the Hospitalization of                                            )  

                                                                      )  

               

LINDA M.                                                                                                                                

                                                                      )     Superior Court No. 3AN-16-01656 PR  

                                                                      )  

                                                                      )  

                                                                      )  



                      A                                                                                            

                         ppeal in File No. S-15859 from the Superior Court of the  

                                                                                                                

                      State  of  Alaska,  Third  Judicial  District,  Anchorage,  John  

                                                                                                                  

                      Suddock,  Judge.                Appeal  in  File  No.  S-16467  from  the  

                                                                                                           

                      Superior Court of the State of Alaska, Third Judicial District,  

                                                                    

                      Anchorage, Mark Rindner, Judge.  



                                                                                                                  

                      Appearances:  Rachel Cella, Assistant Public Defender, and  

                                                                                                        

                      Quinlan Steiner, Public Defender, Anchorage, for Appellant  

                                                                                                      

                      Naomi B.  James B. Gottstein, Law Project for Psychiatric  

                                                                                                                    

                      Rights, Inc., Anchorage, for Appellant Linda M.  Joanne M.  

                                                                                                        

                      Grace        and      Laura        Fox,       Assistant         Attorneys           General,  

                                                                                                            

                      Anchorage,and JahnaLindemuth,Attorney General,Juneau,  

                                                          

                      for Appellee State of Alaska.  



                                                                                                            

                      Before: Stowers, Chief Justice, Winfree, Maassen, Bolger,  

                                            

                      and Carney, Justices.  


----------------------- Page 2-----------------------

                                        STOWERS, Chief Justice, and CARNEY, Justice.                                                                                

                                       BOLGER, Justice, concurring.                            



 I.                 INTRODUCTION  



                                       We are presented with two separate appeals from involuntary commitment                                                                                                           



 orders, brought by two appellants, one of whom also appeals a related involuntary                                                                                                                                       



 medication order.                                      The challenged orders expired while the respective appeals were                                                                                                                      



 pending; we consolidated the cases for briefing on whether to revisit our mootness                                                                                                                                            



jurisprudence in involuntary commitment and involuntary medication appeals. We now                                                                                                                                                              



 hold that all appeals of involuntary admissions for treatment and involuntary medication                                                                                                                                   



 are categorically exempt from the mootness doctrine.                                                                                                        After reviewing each case on its                                                        



 merits and finding no error in the orders appealed, we affirm.                                                                                                



 II.                FACTS AND PROCEEDINGS                      

                    A.                 Naomi B.                      1  



                                       In January 2015 Adult Protective Services petitioned for an ex parte order  

                                                                                                                                                                                                                                            



 committing Naomi B. to the Alaska Psychiatric Institute (API).   She agreed to stay  

                                                                                                                                                                                                                                               



 voluntarily  and  to  take  medication,  attend  groups  and  meetings,  and  plan  for  her  

                                                                                                                                                                                                                                                 



 discharge.   But after her admission she refused to take medication or participate in  

                                                                                                                                                                                                                                                     



 treatment.  



                                       Naomi'sstatesoon worsened. Shereported being repeatedly raped, hit, and  

                                                                                                                                                                                                                                                  



 assaulted, but API found no evidence to support her allegations after conducting a  

                                                                                                                                                                                                                                                       



 physical examand reviewing tapes fromthe facility's surveillance cameras. Her treating  

                                                                                                                                                                                                                                      



 psychiatrist, Dr. David Mack, concluded that Naomi's reports were delusions caused by  

                                                                                                                                                                                                                                                     



 mental illness, and he diagnosed her with schizoaffective disorder, bipolar subtype.  

                                                                                                                                                                                                                          



                    1  

                                                                                                                                                                                                                                      

                                       Pseudonyms have been used throughout this opinion to protect the privacy  

                   

 of the parties.  



                                                                                                                          -2-                                                                                                                            7328  


----------------------- Page 3-----------------------

                                            Naomi never demanded to be discharged from API, and while she ate and                                                                                                                                                               



maintained her personal hygiene, she could not or would not cooperate with API staff  



to plan for her discharge. Concerned that she could not manage her treatment or housing                                                                                                                                                                           



outside of API, hospital staff filed a petition later that month to involuntarily commit                                                                                                                                                                           



Naomi for 30 days.                                                The petition alleged that Naomi was "gravely disabled and there                                                                                                                                          



 [was] reason to believe that [her] mental condition could be improved by the course of                                                                                                                                                                                              



treatment sought."                                             API also petitioned the court to approve involuntary administration                                                                                                           



of psychotropic drugs.                                



                                            That same day a magistrate judge held hearings on both petitions.                                                                                                                                                       Naomi  



was represented by an attorney at the hearings, but declined to participate in person. The                                                                                                                                                                                     

                                        2  testified that Naomi had refused to meet with her, that she was therefore  

court visitor                                                                                                                                                                                                                                                 



unable  to  offer  an  opinion  about  Naomi's  capacity  to  give  informed  consent  to  

                                                                                                                                                                                                                                                                                    



medication, and that she had been unable to find any advance health care directive in  

                                                                                                                                                                                                                                                                                     

Naomi's medical records.3  

                                                          



                                            The court next addressed the involuntary commitment petition.  Dr. Mack  

                                                                                                                                                                                                                                                                         



testified that outpatient treatment would not be adequate for Naomi because she was "at  

                                                                                                                                                                                                                                                                                   



great risk for exposure to disorganized, aggressive behaviors if she's not surround[ed]  

                                                                                                                                                                                                                                     



by a professional staff." Dr. Mack also indicated that Naomi was "unable to engage with  

                                                                                                                                                                                                                                                                              



 [API's] treatment team on basic needs due to her delusional construct" and that API had  

                                                                                                                                                                                                                                                                                



not been able to confirm that Naomi had a safe place to live.  As a result he believed  

                                                                                                                                                                                                                                                                



                      2                     When an involuntary medication petition is filed, the superior court is                                                                                                                                                                   



required to appoint an independent court visitor to assist in investigating whether a                                                                                                                                                                                                  

patient   has   capacity  to   give   or   withhold   informed   consent   to   the   administration   of  

psychotropic medication.                                                             AS 47.30.839(d).   



                      3                     An advance health care directive could have indicated Naomi's position  

                                                                                                                                                                                                                                                                 

regarding psychotropic medication.  See AS 47.30.839(d)(2).  

                                                                                                                                                   



                                                                                                                                          -3-                                                                                                                               7328
  


----------------------- Page 4-----------------------

                                                                                                                             

there was no less restrictive placement where Naomi could receive treatment. The court  



                                                                                                                        

granted the petition, finding that Naomi was "mentally ill and, as a result, gravely  



                                                                                         

disabled," and that there was no less restrictive treatment alternative.  



                                                                                                               

                    The court then turned to the petition for court approval of administration  



                                                                                                                              

of  psychotropic medication.   Dr. Mack testified that API sought to administer two  



                                                                                                                               

medications  to  Naomi:                olanzapine,  an  antipsychotic  to  address  her  delusions,  and  



                                                                                                                                      

lorazepam to reduce anxiety and irritability and to treat some side effects of olanzapine.  



                                                                                                                                

Dr. Mack acknowledged risks associated with both medications but concluded that the  



                                                                                                                        

benefits outweighed the risks.  He hoped that the medications could improve Naomi's  



                                                                                                                       

condition within a week.  He believed that Naomi had no ability to give or withhold  



                                                                                                                                  

informed consent to the administration of the medications, that the medications were in  



                                                                                                                       

her  best  interests,  and  that  there  was  no  less  intrusive  means  of  treating  Naomi's  



                                                                                                                                 

schizoaffective disorder.  He also said that Naomi would be offered various forms of  



                                                                                                                           

group treatment to help her manage her illness, but that the group therapies alone would  



                                                                                            

not successfully treat Naomi's disorder.  The court granted the petition for medication  



                                                                                                                  

"with the amendment that the lorazepam [was to be administered] only as needed."  



                                                                                                                               

                    Naomi's lawyer did not question witnesses, raise objections, or make any  



                           

arguments to the court.  



                                                                                                                             

                    The magistrate judge issued a written report detailing the factual and legal  



                                                                                                                        

findings   from  the   hearing;   the   superior   court   adopted   the   magistrate   judge's  



                                                                                        

recommended findings and signed the attached orders in February.  



                                                                                                                               

                    Naomi appeals, arguing that the superior court erred in finding that she was  



                                                                                                                   

gravely disabled, that there was no less intrusive alternative to involuntary medication,  



                                                                                                                                  

and that forced medication was in her best interests.  Naomi requests that we reverse or  



                                                              

vacate the commitment and medication orders.  



                                                                -4-                                                         7328
  


----------------------- Page 5-----------------------

                                

          B.        Linda M.  



                                                                                                                            

                    Linda M. has a history of mental health issues spanning most of her adult  



                                                                                                                                 

life.  By 2016 she had exhibited paranoia and aggressive behavior, such as spitting at  



                                                                                                                            

people, and kicking and throwing things.  The Anchorage Police Department's crisis  



                                                                                                                              

intervention team responded several times to calls from Linda's mother reporting that  



                                                                                                                                     

Linda was threatening her. The police described Linda as "agitated" and "very volatile,"  



                                                                                                                         

and they eventually arrested Linda for threatening her mother with a shovel and spitting  



                        

on her.  At the time Linda was already facing a criminal charge for reckless driving in  



                                   

connection with a car accident.  



                                                                                                                                

                    While in custody for the two criminal cases, Linda was sent to API for an  



                                                                                                                                  

evaluation and restoration of her competency to stand trial.  In July 2016 API filed a  



                                                                                                                       

petition  to  commit  Linda  for  30  days.                      During  the  commitment  hearing,  Linda's  



                                                                                                                             

testimony seemed paranoid and delusional, including statements that members of a drug  



                                                                                                                           

cartel had attempted to poison her; a psychiatric nurse practitioner testified that Linda  



                                                                                                                           

had schizophrenia. The court found that Linda had a mental illness and as a result posed  



                                                                                                                                

a "substantial risk of harm to others."  It granted API's petition to commit Linda for up  



                                                                                                                               

to 30 days.  During her commitment, Linda voluntarily participated in therapy, but she  



                                                                                                                               

also swore, lunged, and swung at various API staff members, raising concerns about her  



                                                                                                                               

unpredictability and aggressive behavior. The therapy did not lead to improvement, and  



                                                                                      

the efficacy of the drugs administered by API remained unclear.  



                                              

                    In August 2016 API filed a petition to commit Linda for another 90 days  



                                                                                                                    

and  Linda  requested  a  jury  trial.                 During  the  trial  Linda  offered  further  testimony  



                                                                                                                   

reflecting paranoid delusions.  The jury unanimously found by clear and convincing  



                                                         

evidence that Linda was mentally ill and that as a result she was "likely to cause harm  



     

to others."  



                                                               -5-                                                         7328
  


----------------------- Page 6-----------------------

                                                                                                                                  

                    Approximately one week after the jury verdict, the superior court held an  



                                                                                                                                       

evidentiaryhearingon whether therewasanylessrestrictivealternativeto hospitalization  



                                                                                                                            

at API. Various experts testified and several alternatives were explored. An API mental  



                                                                                                                               

health clinician who was certified as an expert in API discharge planning testified that,  



                                                                                                                                

because Linda was not taking medication as prescribed, she would not be accepted into  



                                                                                                                             

a publicly funded assisted living home.  The clinician also testified that a halfway house  



                                                                                                                                  

for  formerly  incarcerated  individuals  would  not  be  appropriate  for  Linda,  even  in  



                                                                                                                         

conjunction with a community support program, and that privately operated assisted  



                                                                                                                               

living  facilities  would  likely  reject  Linda  because  of  her  unpredictability  and  



                                                                                                                            

aggressiveness.   An API psychiatric nurse practitioner similarly testified that Linda  



                                                                                                                           

needed to be stabilized using medication at API before her release, that she still needed  



                                                                                                                            

"24/7 . . .  supervision," and that releasing Linda into the community at that time would  



                      

set her up for failure.  



                                                                                                                                  

                     Finally, a clinical psychiatrist testified that Linda could be discharged to an  



                                                

outpatient community support program if safe housing could also be arranged for her,  



                                                                                                                     

such as an assisted living facility or other location with professional staff that could  



                                                                                                              

"retain her" if she became agitated.  He also discussed a closed facility, Soteria-Alaska,  



                                                                                                                                 

as a less restrictive alternative to API.  He testified that Soteria-Alaska had operated for  



                                                                                                                        

seven years in Anchorage and had offered an alternative to the psychiatric inpatient  



                                                                                                                                  

hospitalization offered at API, but one that still provided "24/7" supervision.  But he  



                                                                     

testified that Soteria-Alaska was shut down due to funding issues.  He opined Soteria- 



                                                                                                       

Alaska would have been a good option for Linda if it were still in operation.  



                                                                                                                                 

                     Linda's counsel asserted during closing argument that the evidence had not  



                                                                                                                                       

established a high probability that a less restrictive alternative would be unsuccessful.  



                                                                                                                                       

Counsel also argued that Linda "ha[d] the constitutional right to a Soteria-like setting."  



                                                                -6-                                                          7328
  


----------------------- Page 7-----------------------

 More specifically, counsel argued that "the state cannot de-fund Soteria-Alaska and then                                                                                                                                                                                                                                                                                                                                                                                                                                 



 say that because we haven't funded it, there is no less-restrictive alternative."                                                                                                                                                                                                                                                                                                                             



                                                                                   The superior court determined that, given the jury finding that Linda was                                                                                                                                                                                                                                                                                                                                                               



 likely to cause harm to others, "a less restrictive alternative would have to . . . protect                                                                                                                                                                                                                                                                                                                                                                                         



 others from physical injury."                                                                                                                                                               The court reasoned that "none of the less restrictive                                                                                                                                                                                                                                 



 alternatives that have been proposed by [Linda] or would otherwise be available will                                                                                                                                                                                                                                                                                                                                                                                                                                                                  



protect . . . the public from the danger to others that [Linda] currently [poses]."                                                                                                                                                                                                                                                                                                                                                                                                                                  The  



 court explained that when Linda becomes agitated, it happens quickly, and that no less                                                                                                                                                                                                                                                                                                                                                                                                                                     



 restrictive alternative was sufficient to protect the public "other than a facility like API                                                                                                                                                                                                                                                                                                                                                                                                                             



 that is locked and [that] provides 24/7 care."  Finally, with regard to Soteria-Alaska as                                                                                                                                                                                                                                                                                                                                                                                                                                            



 a proposed alternative, the court stated, "I reject the idea that there's a constitutional right                                                                                                                                                                                                                                                                                                                                                                                                                      



 that would require the state to fund particular kinds of programs.                                                                                                                                                                                                                                                                                                                                                                    There would be                                                                             



 separation of powers issues, I believe."                                                                                                                                        



                                                                                   The superior court found that there was no less restrictive alternative to                                                                                                                                                                                                                                                                                                                                                                         



 commitment at API.                                                                                                              Linda appeals, arguing that the court erred by rejecting Soteria-                                                                                                                                                                                                                                                                                               



 Alaska as a feasible less restrictive alternative, and that her commitment order therefore                                                                                                                                                                                                                                                                                                                                                                                                 



 violated her constitutional right not to be hospitalized where a feasible less restrictive                                                                                                                                                                                                                                                                                                                                                                                          



 alternative exists. She requests that we reverse and vacate the 90-day commitment order.                                                                                                                                                                                                                                                                                                                                                                                                                       



 III.                                     STANDARD OF REVIEW                                                                                               



                                                                                   "We apply our independent judgment to issues of mootness because as a                                                                                                                                                                                                                                                                                                                                                                   

                                                                                                                                                                                                                                                                                                                                                 4  We review the superior court's  

 matter of judicial policy, mootness is a question of law."                                                                                                                                                                                                                                                                                                                                                                                                                                              



 factual findings in involuntary commitmentormedication proceedings for clear error and  

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              



 reverse those findings only if we have a "definite and firm conviction that a mistake has  

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               



                                          4                                       In re Tracy C.                                                                        , 249 P.3d 1085, 1089 (Alaska 2011) (quoting                                                                                                                                                                                                                                         Clark v. State,                                     



Dep't of Corr.                                                                          , 156 P.3d 384, 386 (Alaska 2007));                                                                                                                                                                                      see also In re Jacob S.                                                                                                                  , 384 P.3d 758,                                               

 764 (Alaska 2016).                                                           



                                                                                                                                                                                                                                                                   -7-                                                                                                                                                                                                                                                 7328
  


----------------------- Page 8-----------------------

                     5  

been made."               However, whether those findings meet the statutory requirements for                                              



involuntary commitment or medication is a question of law to which we apply our                                                           



                                      6 

                                                  

independent judgment.   The independent-judgment standard also applies to questions  



                                                                                                                                          

regarding the interpretation of constitutional and statutory provisions, adopting "the rule  



                                                                                                                       7  

                                                                                                                          

of law that is most persuasive in light of precedent, reason, and policy." 



IV.	       DISCUSSION  



                                                                                                                                                  

           A.	        We  Will  Consider  The  Merits  Of  Naomi's  And  Linda's  Appeals  

                                                                                                                                           

                      Because We Hold That The Public Interest Exception Applies To All  

                                                                                                   

                      Appeals From Involuntary Admission For Treatment.  



                                                                                                                                  

                      As  typically  happens  in  involuntary  admission  for  treatment  appeals,  



                                                                                                                                       

Naomi's and Linda's commitment orders and Naomi's medication order expired while  



                                                                                                                              

their appeals were pending. Under our prior ruling in Wetherhorn v. Alaska Psychiatric  



                                                                              8 

                                                                                                                         

Institute, this would render their appeals moot.   In its initial briefing in Naomi's case,  



                                                                                                                                           

the State argued that Naomi's case should be dismissed as moot.  Naomi argued that her  



                                                                                                                                9  

                                                                                                                                           

case fell under both the public interest exception to the mootness doctrine                                                        and the  



           5          In  re   Jacob   S.,   384   P.3d   at   763-64   (quoting   Wetherhorn   v.  Alaska  



Psychiatric  Inst.,   156  P.3d  371,  375  (Alaska  2007)).  



           6          Id. at 764 (citing Wetherhorn, 156 P.3d at 375).  

                                                                                              



           7          Id.  (quoting   Wetherhorn,   156  P.3d  at  375).  



           8           156  P.3d  at  380-81   (holding  appeal  of  commitment  order  moot  as  30-day  



commitment  period  had  ended).  



           9          See In re Heather R., 366 P.3d 530, 532 (Alaska 2016) (applying public  

                                                                                                                                      

interest exception to reach merits of due process challenge to expired evaluation order);  

                                                                                                                                     

see also In re Daniel G., 320 P.3d 262, 267-68 (Alaska 2014) (applying public interest  

                                                                                                                                    

exception to due process challenge to ex parte 72-hour involuntary evaluation order).  

                                                                                                                                                  

An otherwise moot claim may be considered under the public interest exception if:  (1)  

                                                                                                                                            

"the disputed issues are capable of repetition"; (2) applying the mootness doctrine "may  

                                                                                                                                        

                                                                                                                         (continued...)  



                                                                      -8-	                                                             7328
  


----------------------- Page 9-----------------------

                                                                10  

collateral consequences exception.                                   She also argued, alternatively, that merit-based                  



review of commitment appeals was mandated by federal due process concerns and that                                                                    

                                                                                                        11   We rejected this statutory  

she had a statutory right to appeal under AS 47.30.765.                                                                                      

                                                                     12 but Naomi argued that we should overrule that  

argument in In re Mark V. (Mark V. I),                                                                                                                 

                                                                  



decision.  



                        In Linda's case the State suggested that we could consider the merits of  

                                                                                                                                                         



Linda's case under the public interest exception.  Linda agreed that we should do so, or,  

                                                                                                                                                        



alternatively,  that  we  should  revisit  our  mootness  jurisprudence  in  the  involuntary  

                                                                                                                                        



commitment context andhear all appeals ofpsychiatricconfinementorderson themerits.  

                                                                                                                                                 



We consolidated the two cases on appeal and asked all parties for supplemental briefing  

                                                                                                                                               



on whether - and if so, how - we should revisit our case law on moot involuntary  

                                                                                                                                        



commitment and medication appeals.  

                                                      



            9           (...continued)  



                                                                                                                                                         

cause review of the issues to be repeatedly circumvented"; and (3) the issues "are so  

                                                                                                                                               

important to the public interest as to justify overriding the mootness doctrine." Heather  

                                                                                                                   

R., 366 P.3d at 532 (quoting Wetherhorn, 156 P.3d at 380-81).  



            10          See In re Joan K., 273 P.3d 594, 597-98 (Alaska 2012) ("[T]he collateral  

                                                                                                                                            

consequences doctrine 'allows courts to decide otherwise-moot cases when a judgment  

                                                                                                                                            

may carry indirect consequences in addition to its direct force, either as a matter of legal  

                                                                                                                                                     

rules or as a matter of practical effect.' "(quoting Peter A. v. State, Dep't of Health &  

                                                                                                                                                          

Soc. Servs., Office of Children's Servs., 146 P.3d 991, 994-95 (Alaska 2006))).  Our  

                                                                                                                                                     

application of the collateral consequences exception in Joan K. was limited to appeals  

                                                                                                     

from a person's first involuntary commitment order.  Id. at 598.  

                                                                                                            



            11          AS 47.30.765 provides:  "The respondent has the right to an appeal from  

                                                                                                                             

an order of involuntary commitment.   The court shall inform the respondent of this  

                                                                                                                                                      

right."  



            12          324 P.3d 840, 847-48 (Alaska 2014).  

                                                                                              



                                                                            -9-                                                                    7328
  


----------------------- Page 10-----------------------

                                        We do not lightly overturn our previous decisions.                                                                                                       After reexamining our                                      



decisions regarding the mootness doctrine as applied to cases involving involuntary                                                                                                                                               



admission for treatment and medication, and in light of the broad agreement in the                                                                                                                                                                         



supplemental briefing regarding the practical consequences that have followed from                                                                                                                                                                    



those decisions - discussed in more detail below - we are persuaded that our previous                                                                                                                                                       



rulings with regard to mootness in these contexts were mistaken and that more good than                                                                                                                                                                  



harm will come from overturning them.                                                                                     



                                         1.	                 Mootness   in   commitment   appeals   -    Wetherhorn    and    its  

                                                             progeny  



                                        A history of our mootness jurisprudence is useful for context. Although the                                                                                                                                          



legislature amended Alaska's mental health statutes in 1981 in response to a nationwide                                                                                                                                           

                                                                                               13 we heard few appeals from such cases until more than  

shift in mental health treatment,                                                                                                                                                                                                                        



20 years later.  In 2007, in Wetherhorn v. Alaska Psychiatric Institute, we considered a  

                                                                                                                                                                                                                                                                  



constitutional challenge to the statutory definition of "grave disability" and a due process  

                                                                                                                                                                                                                                               



challenge to the proceedings in which the appellant was involuntarily committed to API  

                                                                                                                                                                                                                                                          

for 30 days.14   The appellant also challenged the sufficiency of the evidence underlying  

                                                                                                                                                                                                                                     



her commitment, but we declined to consider that challenge because the commitment  

                                                                                                                                                                                                                               

period had "long since passed," rendering the question moot.15                                                                                                                                             We considered but  

                                                                                                                                                                                                                                                           



declined  to  apply  the  public  interest  exception,  reasoning  that  "Wetherhorn  was  

                                                                                                                                                                                                                                                        



committed based on a specific set of facts," that "[i]f it were to become necessary to seek  

                                                                                                                                                                                                                                                         



Wetherhorn's commitment again, the hearing would be based on a different set of facts  

                                                                                                                                                                                                                                                       



specific  to  different  circumstances,"  and  that  "factual  questions  are  not  capable  of  

                                                                                                                                                                                                                                                              



                    13                   Ch. 84,  1, SLA 1981.                               



                    14                   156 P.3d at 375-80.                 



                    15  

                                                          

                                        Id. at 380-81.  



                                                                                                                             -10-	                                                                                                                     7328
  


----------------------- Page 11-----------------------

                            16  

 repetition."                     Wetherhorn  thus established that appeals from commitment orders are                                                                                                    



 moot when the appellant has already been released before the appeal is heard and that the                                                                                                                 



public interest exception would apply only to generally applicable questions of law and                                                                                                                  



 not to questions of fact like sufficiency-of-the-evidence challenges.                                                                   



                                 Our 2012 opinion in                                 In re Joan K.                        departed from the strict holding of                                               



 Wetherhorn  and adopted a "collateral consequences exception" to the mootness doctrine                                                                                                       

                                                                                       17  The appellant in that case noted that several other  

 in involuntary commitment appeals.                                                                                                                                                                   



jurisdictions   had   applied   the   collateral   consequences   exception   to   involuntary  

                                                                                                                                                                                   



 commitment appeals on the basis of, for example, "social stigma, adverse employment  

                                                                                                                                                                                    



 restrictions, application  in  future legal proceedings,  and  restrictions on the right to  

                                                                                                                                                                                                            

possess  firearms."18                                    We  concluded  "that  there  are  sufficient  general  collateral  

                                                                                                                                                                                         



 consequences, without the need for a particularized showing, to apply the doctrine in an  

                                                                                                                                                                                                            

 otherwise-moot appeal from a person's first involuntary commitment order."19  Because  

                                                                                                                                                                                                                    



Joan K. involved the appellant's first involuntary commitment, we reviewed the merits  

                                                                                                                                                                                                   

                                                                            20       But  we  also  "note[d]  that  some  number  of  prior  

 of  her  evidentiary  challenges.                                                                                                                                                                   

                                                



 involuntary  commitment orders would  likely eliminate the possibility of additional  

                                                                                                                                                                                         



                 16             Id.  at  381.  



                 17              273  P.3d  594,  596-98  (Alaska  2012).  



                 18             Id.  at  597  (footnotes  omitted)  (first  citing  In  re  Alfred  H.H.,  910  N.E.2d  74,  



 84  (Ill.  2009);  State  v.  Lodge,  608  S.W.2d  910,  912  (Tex.  1980);  State  v.  J.S.,  817  A.2d  

 53,  55-56  (Vt.  2002);  then  citing  Alfred  H.H.,  910  N.E.2d  at  84;  then  citing  Alfred  H.H.,  

 910  N.E.2d  at  84;  In  re  Hatley,  231  S.E.2d  633,  634-35  (N.C.   1977);  and  then  citing  In  

 re   Walter  R.,  850  A.2d  346,  349  (Me.  2004)).  



                 19             Id. at 598.  

                                               



                 20             Id. at 598-602.  

                                               



                                                                                                    -11-                                                                                              7328
  


----------------------- Page 12-----------------------

                                                                                                                             21  

 collateral consequences, precluding the doctrine's application."                                                                To illustrate the point,         



we cited          Bigley v. Alaska Psychiatric Institute                                      , which described a " 'revolving door'                              



pattern of arrest, hospitalization, release and relapse" in which the appellant had been                                                                           

                                                                  22    We did not, however, explicitly limit the collateral  

 admitted to API at least 68 times.                                                                                                                       



 consequences exception to an appellant's first involuntary commitment or specify what  

                                                                                                                                                                   



number of prior commitments would render further collateral consequences negligible.  

                                                                                                                                                        



                           Joan K. also cursorily presented thequestion whether AS 47.30.765, which  

                                                                                                                                                                 



provides that the respondent to an involuntary commitment petition "has the right to an  

                                                                                                                                                                        



 appeal from an order of involuntary commitment," supersedes the mootness doctrine in  

                                                                                                                                                                         

this context.23               Because we adopted and applied the collateral consequences exception,  

                                                                                                                                                        

we did not reach this question, but we expressed some skepticism.24                                                                     We addressed this  

                                                                                                                                                                      

                                                                      25    There we noted that other statutes also provide  

 issue two years later in Mark V. I .                                                                                                                        

                                                                    

 "rights  of  appeal  equivalent  to  those  provided  by  AS  47.30.765"26                                                                   and  that  "[t]he  

                                                                                                                                                                



 existence of these statutes ha[d] not in practice compelled us to review otherwise-moot  

                                                                                                                                              



              21           Id.  at 598.   



              22           Id.  at 598 n.18 (citing                  Bigley v. Alaska Psychiatric Inst.                              , 208 P.3d 168, 172-           



 73 (Alaska 2009)).  

                        



              23           Id. at 597.  

                                       



              24           Id. ("Although Joan's interpretation of the statute as overriding the judicial  

                                                                                                                                                              

policy of not deciding moot cases appears overbroad, we do not need to address this  

                                                                                                                                                                     

 argument . . . .").  

                           



              25           324 P.3d 840, 847-48 (Alaska 2014).  

                                                                                         



              26           Id. at 847 (first citing AS 47.10.080(i) (right to appeal judgments in child- 

                                                                                                                                                                 

 in-need-of-aid proceedings); then citing AS 22.05.010(c) (right to appeal administrative  

                                                                                                                                                 

 agency decisions to the superior court); AS 22.07.020(d) (providing that "[a]n appeal to  

                                                                                                                                                                         

the  court  of  appeals  is  a  matter  of  right  in  all  actions  and  proceedings  within  its  

                                                                                                                             

jurisdiction")).  



                                                                                  -12-                                                                            7328
  


----------------------- Page 13-----------------------

               27  

appeals."          We concluded the statute did not "requir[e] appellate review of a moot civil                                     

commitment dispute."                28  



                      Our opinion in In re Dakota K. addressed the question - left unresolved  

                                                                                                                          



by Joan K. - of which party bears the burden to show the existence or non-existence  

                                                                                                                 

of collateral consequences.29  We concluded that the party opposing mootness bears "the  

                                                                                                                                     

burden to establish the fact of collateral consequences."30                                  Because the appellant in that  

                                                                                                                                      



case  had  not  made  a  showing  or  even  alleged  that  the  challenged  involuntary  

                                                                                                                        



commitment was his firstor that any other collateral consequences applied, we dismissed  

                                                                                                                            

the appeal as moot.31  

                       



                      That same year we addressed a procedural issue concerning mootness in  

                                                                                                                        

In re Reid K.32   We recognized that because the mootness issue was first addressed in the  

                                                                                                                                       



State's appellee's brief, the appellant had not had a chance to demonstrate that his claims  

                                                                                                                                 



were not moot or that they fell within a mootness exception doctrine until the reply  

                                                                                                                                   

         33  To remedy this procedural hurdle, we suggested that it would be "best practice  

brief.                                                                                                                         



           27        Id.  at  847-48.  



           28        Id.  at  848.  



           29         354  P.3d   1068,   1071-72  (Alaska  2015).  



           30        Id.  at   1072-73.  



           31        Id.  at   1073.  



           32         357  P.3d  776,  782-83  (Alaska  2015).  



           33        Id.  at  782.   This  is  problematic  because,  under  Alaska  Appellate  Rule  212,  



a  reply  brief  is  limited  to  20  pages  and  must  be  filed  within  20  days  after  service  of  the  

appellee's  brief.   Where  mootness  is  raised  for  the  first  time  in  the  appellee's  brief,  this  

could make it difficult for the  appellant to address the issue in full  within the time and  

space  restrictions  of  a  reply  brief  without  forgoing  substantive  arguments.  



                                                                  -13-                                                             7328
  


----------------------- Page 14-----------------------

for the State to move to dismiss appeals of commitment orders as moot before briefing                                                     



                                                                                                            34  

commences when no mootness exception is readily apparent."                                                                                        

                                                                                                                 We explained that this  



                                                                                                                                        

procedure  might  "save  scarce  public  attorney  and  judicial  resources  by  avoiding  



                                                                                                                                    35  

                                                                                                                           

merits-based briefing" in cases that would ultimately be dismissed as moot. 



                       2.	         Our   mootness   jurisprudence   has   proved   unworkable   in  

                                                                                                                                                   

                                   practice.  



                       In their supplemental briefing the parties agree that over the past decade,  



our  mootness  jurisprudence  as  applied  to  involuntary  commitment  and  medication  

                                                                                                                                    



appeals has resulted in significant time and effort spent addressing mootness issues.  

                                                                                                                                                          



Counsel for both the State and Naomi indicate that in commitment appeals, briefing and  

                                                                                                                                                  



litigating mootness is often more time- and resource-consuming than addressing the  

                                                                                                                                                   



actual merits of any particular case. The State argues that "[t]he collateral consequences  

                                                                                                                                



exception can be particularly difficult to litigate because its applicability can hinge on  

                                                                                                                                                    



facts that may not be in the appellate record."  

                                                                  



                       The procedure we laid out in Reid K. for a pre-briefing motion to dismiss  

                                                                                                                                           



on mootness grounds was not used in either of these cases.  Naomi's attorney, a public  

                                                                                                                                             



defender, indicates that "in appeals involving the Public Defender Agency, it does not  

                                                                                                                                         



appear that the Reid K. [procedure] has been utilized at all."  The State concedes that it  

                                                                                                                                                      



has not effectively implemented the Reid K. procedure, noting that it can be difficult to  

                                                                                                                                                     



determine if the issues raised on appeal would fall within a mootness exception before  

                                                                                                                                             



the appellant's arguments are articulated in the opening brief. Naomi further argues that  

                                                                                                                                                  



even if the Reid K. procedure had been used, addressing the potential applicability of a  

                                                                                                                                                      



mootness exception "entails reviewing the record, researching the relevant issues, and  

                                                                                                                                     



            34         Id.  



            35         Id.  at  783.  



                                                                        -14-                                                                        7328  


----------------------- Page 15-----------------------

 filing a detailed response to the dismissal motion that is not unlike a merits-based brief."                                                                                                                                                                    



Thus, she argues, if a mootness exception even arguably applies, using the                                                                                                                                                           Reid K.   



procedure   merely   "shifts   resources   to   an   earlier  stage   in  the   case   but   does   not  



meaningfully save them."                                



                                       A review of our past and pending cases also indicates that mootness has                                                                                                                                      



dominated appeals in theinvoluntary                                                                        commitment context: as                                                 of February 2018 -when                                      



we heard oral arguments on this issue - all but three of our prior decisions in post-                                                                                                                                                          



 Wetherhorn   commitment   appeals   directly   addressed,   to   some   extent,   whether   the  

                                                                                         36      Similarly, of the commitment cases pending before us  

commitment appeal was moot.                                                                                                                                                                                                                             



that had been fully briefed at that time, almost all included briefing on mootness.  

                                                                                                                                                                                                                



                                       We have consistently held that we will not reconsider prior rulings without  

                                                                                                                                                                                                                                        



compelling reasons for doing so:  "We will overrule a prior decision only when clearly  

                                                                                                                                                                                                                                          



convinced  that the rule was originally  erroneous or  is no  longer  sound  because of  

                                                                                                                                                                                                                                                       



changed conditions, and that more good than harm would result from a departure from  

                                                                                                                                                                                                                                                



                    36                 See In re Mark V.                                     (Mark V. II                        ), 375 P.3d 51, 55-56 (Alaska 2016);                                                                          In re   



Heather R.                       , 366 P.3d 530, 532 (Alaska 2016);                                                                      In re Reid K., 357 P.3d at 780-83;                                                                    In re   

Dakota K.                      , 354 P.3d at 1070-73;                                           Mark V. I                  , 324 P.3d 840, 843-48 (Alaska 2014);                                                                               In re   

Daniel G.                    , 320 P.3d 262, 267-69 (Alaska 2014);                                                                          In re Stephen O.                                , 314 P.3d 1185, 1191-                           

 92 (Alaska 2013);  In re Jeffrey E.                                                                , 281 P.3d 84, 86 (Alaska 2012);                                                                  In re Joan K.                            , 273   

P.3d 594, 596-98 (Alaska 2012);                                                                 In re Tracy C.                          , 249 P.3d 1085, 1089-91 (Alaska 2011);                                                            

Bigley v. Alaska Psychiatric Inst.                                                                   , 208 P.3d 168, 179 (Alaska 2009);                                                                          E.P. v. Alaska          

Psychiatric Inst.                               , 205 P.3d1101,1106-08 (Alaska2009);                                                                                WayneB. v. Alaska Psychiatric                            

Inst., 192 P.3d 989, 990-91 (Alaska 2008);                                                                                        Maness v. Daily                                  , 184 P.3d 1, 7-8 (Alaska                           

2008).  



                                                                                                                                                                                                                                                   

                                       The outliers are Wetherhorn v. Alaska Psychiatric Institute, 167 P.3d 701  

                                                                                                                                                                                                                                                  

 (Alaska 2007), which addressed only an attorney's fee dispute arising out of the first  

                                                                                                                                                                                                                          

 Wetherhorn  case,  and  two  cases  where  we  addressed  the  challenged  involuntary  

                                                                                                                                                                                                                                        

commitment  without  discussing  mootness,  but  still  considered  whether  a  related  

                                                                                                                                                                                                                                       

involuntary medication appeal was moot. In re Jacob S., 384 P.3d 758, 769-70 (Alaska  

                                                                                                                                                                   

2016); In re Gabriel C., 324 P.3d 835, 837-40 (Alaska 2014).  



                                                                                                                         -15-                                                                                                                  7328
  


----------------------- Page 16-----------------------

                   37  

precedent."             We have recognized that our precedent may be overturned as "originally                                



                                                                                                    38  

erroneous" if it has "prove[d] to be unworkable in practice."                                           



                      As we explained in Dakota K., "[m]ootness is a judicially created doctrine  

                                                                                                                                  

                                                                                       39   Our mootness jurisprudence has  

meant to promote expediency and judicial economy."                                                                                        

                                                                      



failed to achieve these goals: more, rather than fewer, resources of public attorneys and  

                                                                                                                                          



the  court  have  been  spent  litigating  mootness  since  Wetherhorn,  with  few  if  any  

                                                                                                                                         



corresponding savings in resources spent on merits-based briefing.  

                                                                                                 



                      In  light  of  these  factors  it  is  clear  to  us  that  our  current  mootness  

                                                                                                                               



jurisprudence, as it applies to the involuntary commitment context, has indeed proved  

                                                                                                                                    



to be unworkable in practice.  But that does not answer the question of what a more  

                                                                                                                                       



appropriate  rule  would  be.                     To  answer  that,  we  need  to  reconsider  our  mootness  

                                                                                                                               



jurisprudence in more detail.  

                                       



                      3.	        The  public  interest  exception  is  categorically  applicable  to  

                                                                                                                                           

                                 involuntary commitment appeals.  

                                                                               



                      As explained above, we will hear an otherwise moot case where it falls  

                                                                                                                                        



under the public interest exception to mootness.   The State suggests that the public  

                                                                                                                                     



interest exception may always be applicable to justify appellate review of involuntary  

                                                                                                                            



commitment orders.  As we have applied it, the public interest exception depends on  

                                                                                                                                           



three factors:  "(1) whether the disputed issues are capable of repetition, (2) whether the  

                                                                                                                                           



mootness  doctrine,  if  applied,  may  cause  review  of  the  issues  to  be  repeatedly  

                                                                                                                             



           37          Thomas v. Anchorage  Equal  Rights  Comm'n, 102 P.3d  937, 943 (Alaska  



2004)  (quoting  State,  Commercial  Fisheries  Entry  Comm'n  v.  Carlson,  65  P.3d  851,  859  

(Alaska  2003)).  



           38         Khan v. State, 278 P.3d 893, 901 (Alaska 2012) (quoting Thomas, 102 P.3d  

                                                                                                                                        

at 943).  

     



           39         354 P.3d at 1070.  

                                           



                                                                    -16-	                                                              7328
  


----------------------- Page 17-----------------------

circumvented, and (3) whether the issues presented are so important to the public interest                                                           

as to justify overriding the mootness doctrine."                                        40  



                         The second factor will always favor applying the exception in involuntary  

                                                                                                                                             



commitment appeals:  as we explained in E.P. v. Alaska Psychiatric Institute, "[i]t is  

                                                                                                                                                               



quite unlikely that an appeal from a 30-day or 90-day commitment, or even a 180-day  

                                                       

commitment, could be completed before the commitment has expired."41                                                                     And we have  

                                                                                                                                                         



repeatedly held that some issues in involuntary commitment appeals are important to the  

                                                                                                                                                             



public interest - the third factor - because an involuntary commitment is a "massive  

                                                                                                                                                 

curtailment of liberty."42  

                            



                         Wherewehaveconsideredthepublicinterest exception inthepast, wehave  

                                                                                                                                                          



generally held that disputed questions are not "capable of repetition" when they "turn on  

                                                                                                                                                              

                                                                     43   In some cases we have applied this rule strictly.  

unique facts unlikely to be repeated."                                                                                                                              

                                                   



For example, in  Wetherhorn we concluded that the public interest exception did not  

                                                                                                                                                            

                                                                                                                                          44   Similarly,  

apply because "Wetherhorn was committed based on a specific set of facts."                                                                      

                                                                                                                                



in In re Reid K. we concluded that a sufficiency-of-the-evidence challenge based on the  

                                                                                                                                                            



            40           Wetherhorn, 156 P.3d at 380-81 (quoting                                        Akpik v. State, Office of Mgmt.  



& Budget          , 115 P.3d 532, 536 (Alaska 2005)).                   



            41           205 P.3d at 1107; see also Joan K., 273 P.3d at 608 (Stowers, J., dissenting)  

                                                                                                                                              

("[I]t is practically impossible to perfect an appeal of an order that by its terms will  

                                                                                                                                                          

expire in 30 days.").  

                        



            42           Wetherhorn, 156 P.3d at 375 (quoting Humphrey v. Cady, 405 U.S. 504,  

                                                                                                                                                

509 (1972)); accord In re Tracy C., 249 P.3d 1085, 1090 (Alaska 2011) (quoting E.P.,  

                                                                                                                                                         

205 P.3d at 1107).  

                       



            43           E.P., 205 P.3d at 1107; see also Tracy C., 249 P.3d at 1094 ("[T]he public  

                                                                                                                                                      

interest exception to the mootness doctrine applies because Tracy presents a question of  

                                                                                                                                                              

statutory interpretation that is capable of repetition.").  

                                                                              



            44           156 P.3d at 381.  

                                                



                                                                             -17-                                                                       7328
  


----------------------- Page 18-----------------------

alleged unreliability of clinical tests presented as evidence did not fall under the public                                                                   



interest exception because "the trial court is the most appropriate forum in which to                                                                                 



evaluate   and   weigh   competing   fact-based   arguments   regarding   the   reliability  of  

evidence."45  



                          However,  in  other  cases  we  have  applied  the  "capable  of  repetition"  

                                                                                                                                                    



element more flexibly.  For example, in E.P. the appellant raised both legal and factual  

                                                                                                                                                             

challenges to his commitment order.46                                       The latter included the question whether E.P. -  

                                                                                                                                                                     



whose history of alcohol and inhalant abuse had resulted in organic brain damage,  

                                                                                                                                                         

dementia, personality disorder, and psychosis47  - met the statutory requirements for  

                                                                                                                                                                    

involuntary commitment.48   We concluded that "E.P.'s fact-based claims are capable of  

                                                                                                                                                                      



repetition to any addict whose substance abuse causes organic brain damage," even if the  

                                                                                                                                                                   



                                                                                                            49  

abused substance were something other than inhalants.                                                            

                                                                                         



                          On  re-examination,  we  are  persuaded  that  the  "capable  of  repetition"  

                                                                                                                                                    



element should be applied broadly in the context of involuntary commitment appeals,  

                                                                                                                                                          



and that a case need not be capable of being repeated identically in order for the public  

                                                                                                                                                              



interest exception to apply.   Although every involuntary commitment proceeding is  

                                                                                                                                                                      



based  on  a particular set of facts,  such  proceedings  occur  frequently,  and  it is not  

                                                                                                                                                                   



uncommon  for  similar  fact  patterns  to  reoccur,  either  in  a  subsequent  proceeding  

                                                                                                                                                   



             45           357 P.3d 776, 781 (Alaska 2015).                      



             46           205 P.3d at 1107.  

                                                  



             47           Id. at 1103-04.  

                                      



             48           Id.  at 1107.   



             49           Id.  



                                                                                 -18-                                                                           7328
  


----------------------- Page 19-----------------------

                                                                                                 50                                                                                                   51  

involving   the same respondent,                                                                       or   in a different                                    case entirely.                                  Accordingly,   an  



opinion considering whether acommitment                                                                                         order in                onecasewas                            supportedby                            sufficient  



evidence will likely be useful as guidance by analogy to future commitment proceedings.                                                                                                                                                                              



By contrast, declining review of commitment appeals based on mootness effectively                                                                                                                                                



deprives trial courts of guidance on how to apply the statutory requirements to the facts                                                                                                                                                           



of individual cases.                    



                                        We   conclude   that   appeals   from   involuntary   commitment  orders   are  



categorically subject to the public interest exception, whether the appeal is premised on                                                                                                                                                                 



aquestion                      ofstatutory or constitutional interpretation or on an                                                                                                evidence-based challenge.   



While we reaffirm that the trial court is indeed the correct forum for evaluating and                                                                                                                                                                 

                                                                                                                                                       52  and we therefore will not second- 

weighing the reliability and credibility of evidence                                                                                                                                                                                      



guess the trial court's findings of fact where they are supported by evidence in the  

                                                                                                                                                                                                                                                        



record, that does not preclude us from considering whether the findings were clearly  

                                                                                                                                                                                                                                             



erroneous or whether they were sufficient to satisfy legal requirements.  

                                                                                                                                                                                                                       



                    50                  See id.             (noting that                       the circumstances underlying E.P.'s commitment "were                                                                                             



not only capable of repetition . . . , but they were repeated, because E.P. was committed                                                                                                                                         

three times on the same facts").                                        



                    51                  Compare Mark V. II, 375 P.3d 51, 54 (Alaska 2016) (respondent was found  

                                                                                                                                                                                                                                                 

"gravely disabled" because of paranoid schizophrenia causing delusions and bizarre  

                                                                                                                                                                                                                                            

behavior), with Bigley v. Alaska Psychiatric Inst., 208 P.3d 168, 172-73 (Alaska 2009)  

                                                                                                                                                                                                                                                

(same); and compare In re Jacob S., 384 P.3d 758, 762-63 (Alaska 2016) (respondent  

                                                                                                                                                                                  

was found a danger to others after paranoid delusions caused him to attack his neighbor  

                                                                                                                                                                                                                                       

and attempt to set her house on fire on multiple occasions), with In re Reid K., 357 P.3d  

                                                                                                                                                                                                                                                    

776, 777-78 (Alaska 2015) (respondent was found "likely to cause harm to himself or  

                                                                                                                                                                                                                           

others" after acting on hallucinations instructing him to harm and kill others).  

                                                                                                                                                                                                                 



                    52                  See Reid K., 357 P.3d at 781.  

                                                                                                                  



                                                                                                                           -19-                                                                                                                    7328
  


----------------------- Page 20-----------------------

                                       4.	                The public interest exception is also categorically applicable to                                                                                                                         

                                                          involuntary medication appeals.                                           



                                       Just like involuntary commitment proceedings, involuntary medication                                                                                                              



                                                                                                                                                                                                                                                     53  

proceedings implicate "fundamental constitutional guarantees of liberty and privacy."                                                                                                                                                                        



                                                                                                                                                                                                                                                 

And medication petitions are virtually always filed in conjunction with a petition for  



                                                                                                                                                                                                                                                  

involuntary commitment, with hearings on the two petitions often taking place before the  



                                                                                                                                                                                                                   

 same judge on the same day.  As with involuntary commitment appeals, because "it is  



                                                                                                                                                                                                                                                

doubtful that an appeal from a medication order could ever be completed within the  



                                                                                            54  

                                                                                                                                                                                                                                                             

order's period of effectiveness,"                                                                 such cases are likely to routinely evade timely review.  



                                                                                                                                                                                                                                           

                                       We have previously held that the public interest exception applies "in order  



                                                                                                                                                                                                                        

to clarify therequirementsforprotecting constitutionalrights in [involuntary medication]  



                                        55  

proceedings."                                                                                                                                                                                                                                    

                                                Although every involuntary medication order is of course based on the  



                                                                                                                                                                                                                                                             

facts and circumstances of a particular case, similar fact patterns are likely to reoccur.  



                                                                                                                                                                                                                                                 

By continuing to apply the mootness doctrine to involuntary medication appeals, we  



                                                                                                                                                                                                                                

deprive litigants and the superior court of helpful guidance in applying the statutory  



                                                                                                                                                                                                                                                             

framework.  We therefore also conclude that the public interest exception categorically  



                    53                Bigley,208                       P.3d at 179 (quoting  Myers v.Alaska                                                                    PsychiatricInst.                               , 138 P.3d     



238, 250 (Alaska 2006)). We observed in                                                                                 Myers : "Side effects aside, the truly intrusive                                                         

nature of psychotropic drugs may be best understood by appreciating that they are                                                                                                                                                               

literally intended to alter the mind. Recognizing that purpose, many states have equated                                                                                                                                            

the intrusiveness of psychotropic medication with the intrusiveness of electroconvulsive                                                                                                               

therapy and psychosurgery." 138 P.3d at 242 (footnote omitted) (first citing                                                                                                                                                Riggins v.   

Nevada, 504 U.S. 127, 134 (1992); then citing                                                                                           Jarvis v. Levine, 418 N.W.2d 139, 146  

 (Minn. 1988);                            In re K.K.B.                        , 609 P.2d 747, 749 (Okla. 1980)).                                            



                    54                Myers, 138 P.3d at 245.  

                                                                                               



                    55                Bigley, 208 P.3d at 179 (citing Myers, 138 P.3d at 244).  

                                                                                                                                                                                         



                                                                                                                       -20-	                                                                                                                7328
  


----------------------- Page 21-----------------------

applies to involuntary medication appeals, and we will hear all such appeals on the                                                                                                                



                56  

merits.                



                                                                                                                                                                                              

                                5.	            Overturning our mootness jurisprudence would result in more  

                                                                          

                                               good than harm.  



                                                                                                                                                                                                    

                               Now that we have identified a new and better approach to mootness in the  



                                                                                                                                                                                         

involuntary  commitment  and  medication  contexts,  we  must  turn  to  the  second  



                                                                                                                                                                                                     

requirement to depart from stare decisis, which dictates we "balance the benefits of  



                                                                                                                                    57  

                                                                                                                                                                                                    

adopting a new rule against the benefits of stare decisis."                                                                               The benefits of reaching the  



                                                                                                                                                                                                       

merits of involuntary commitment appeals were articulated in the dissenting opinion to  



                                    

In re Joan K. :  



                                                                                                                                                                       

                                Of first importance, the citizen's liberty has been alleged to  

                                                                                                                                                               

                               have  been  wrongfully  taken  by  court  process;  the  court  

                                                                                                                                                                

                                should afford the citizen the opportunity to prove the error  

                                                                                                                                                                

                                and, if proven, obtain judicial acknowledgment that the order  

                                                                                          

                               was erroneously issued.  Giving the citizen this opportunity  

                                                                                                                                                                         

                               will assure the citizen that she will be heard, and that if a  

                                                                                                                                                                      

                                lower court has erred, that error will not go unnoticed or  

                                                                                                                                                                   

                               unremedied, at least to the extent that the erroneous order will  

                                                                                                                                                          

                               be reversed and vacated.  Public confidence in the judicial  

                                                                                                                              

                               branch demands that we hold ourselves accountable.  



                                                                                                                                                          

                                               Second, in this age of prevalent information mining,  

                                                                                                                                                            

                                collection,   and   storage   into   increasingly   large,   inter- 

                                                                                                                           

                                connected, and searchable data banks, the fact that a citizen  

                                                                                                                                                                   

                               has been involuntarily committed to a mental institution will  



                56             We agree with the concurrence's disavowal of                                                                 Mark V.             's limitation of the                



collateral consequences exception to appeals of a first commitment order; however, we                                                                                                               

are unpersuaded by its criticism of the public interest exception's categorical application                                                                                      

to involuntary admission for treatment appeals.  The magnitude of the interest at stake     

in these cases - the deprivation of liberty - removes them from the concurrence's                                                                                         

concern that this exception will be applied to "routine cases."                                                                 



                57             State v. Carlin, 249 P.3d 752, 761 (Alaska 2011).  

                                                                                                                                                      



                                                                                                 -21-	                                                                                         7328
  


----------------------- Page 22-----------------------

                           follow that individual for all of her life.                                    She should be given           

                           the means to effectively challenge that order through appeal                                               

                           regardless of the fact that by the time her appeal is ripe for                                                    

                           decision, the 30 days will have long since expired and she                                                       

                           will   have   been   released  from   State   custody.     The   injury  

                           inflicted   by   an   erroneously   issued   order   of   involuntary  

                           commitment "lives" until the wrong is righted.                                               [58]  



 The same reasoning applies to involuntary medication appeals.  

                                                                                                              



                           On the other side of the scales are the benefits of stare decisis: "providing  

                                                                                                                                                       



 guidance for the conduct of individuals, creating efficiency in litigation by avoiding the  

                                                                                                                                                                       

relitigation of decided issues, and maintaining public faith in the judiciary."59  Declining  

                                                                                                                                                          



to decide such appeals on mootness grounds provides no guidance to the general public,  

                                                                                                                                                                



 and little to no guidance to litigants and the superior court in involuntary commitment  

                                                                                                                      



 and  medication  proceedings.                                  On  the  contrary,  as  suggested  earlier,  our  mootness  

                                                                                                                                                         



jurisprudence may in fact have deprived the superior court of guidance in how to apply  

                                                                                                                                                                  



the civil commitment and forced medication statutes to the facts of individual cases.  

                                                                                                                                                            



                           Second, as discussed above, although our intent was to promote efficiency  

                                                                                                                                                          



 in litigation, experience has shown that this has not happened.  Because the mootness  

                                                                                                                                                          



 doctrine as we have applied it depends on the specific circumstances and arguments  

                                                                                                                                               



raised on appeal, it has instead caused repeated extended litigation over mootness rather  

                                                                                                                                                                  



than over the actual merits of a case.  

                                                               



                           Finally, we conclude that to the extent public faith in the judiciary may be  

                                                                                                                                                                        



harmed by our change of direction in this case, the risk is vastly outweighed by holding  

                                                                                                                                                              



the  judiciary  as  a  whole  accountable  through  merit-based  review  of  involuntary  

                                                                                                                                                     



 commitment and medication orders.  

                                                           



              58           273  P.3d  594,  607-08  (Alaska  2012)  (Stowers,  J.,  dissenting).  



              59           Carlin,  249  P.3d  at  761-62.  



                                                                                  -22-                                                                                   7328  


----------------------- Page 23-----------------------

                                   6.	              We   will   hear   all   involuntary   admission   for   treatment   and  

                                                     involuntary medication appeals on the merits.                                                                



                                   For these reasons, we conclude that the public interest exception applies                                                                                                     



categorically   to   appeals   from   orders   for   involuntary   admission   for   treatment  and  



                                                                60  

involuntary  medication.                                                                                                                                                                                                  

                                                                         We will hear such cases on their merits even where the  



                                                                                                                                                                                                                 

underlying order has expired and the respondent has been released or no longer subject  



                                                        61  

                          

to forced medication. 



                                                                                                                                                                                                                         

                                   Because we conclude that all involuntary admission  for treatment and  



                                                                                                                                                                                                                              

medication appeals are subject to the public interest exception, it is not necessary for us  



                                                                                                                                                                                                                    

to reconsider whether AS 47.30.765 mandates judicial review of otherwise-moot cases,  



                                                                                                                                                                                                               

and we decline to do so; we similarly do not address Naomi's argument that judicial  



                                                                                                                                                                                                              

review  on  the  merits  of  commitment  appeals  is  mandated  by  federal  due  process  



                                                                                                                                                                                                    

concerns.   But to the extent that our prior decisions on mootness in the involuntary  



                                                                                                                                                                                                                        

admission for treatment and medication contexts are inconsistent with this opinion, they  



                                                                                                                                                                                              

are overruled.  We emphasize that because our decision here is based on circumstances  



                  60               We   note   that   this   holding   is  not  limited   to   the   kinds   of   involuntary  



commitment and involuntary medication appeals that Naomi and Linda bring here;                                                                                                                                       

rather, it covers appeals of any order for involuntary hospitalization or treatment in the                                                                                                                                 

mental health context.                                       We have previously applied the public interest exception to at                                                                                                   

least one other type of involuntary hospitalization appeal:                                                                                            a due process challenge to an                                         

order authorizing up to 72 hours' confinement for psychiatric evaluation pursuant to                                                                                                                                          

AS 47.30.715.                           See In re Heather R.                                  , 366 P.3d 530, 532 (Alaska 2016);                                                          In re Daniel G.                         ,  

320   P.3d  262,  268  (Alaska   2014).     We   hold   today   that   regardless   of   the   type   of  

involuntary admission or medication proceeding being challenged or the legal basis for                                                                                                                                      

appeal, the public interest exception authorizes us to consider any such appeal on the                                                                                                         

merits.  



                  61               The parties in futurecommitmentand medication appeals need not brief the  

                                                                                                                                                                                                                            

application of the mootness doctrine or its exceptions, and there is no need for parties in  

                                                                                                                                                                                                                              

superior court proceedings to address collateral consequences for purposes of making a  

                                                                                                                                                                                                                                 

record for appellate review.  

                                                                           



                                                                                                            -23-	                                                                                                     7328
  


----------------------- Page 24-----------------------

unique to appeals from involuntary admission and medication proceedings, our ruling                                                                                                                   



here is limited to such cases and should not be construed as altering in any way our                                                                                                           



approach to mootness in other contexts.                                     



                 B.	             The Superior Courts Did Not Err In Granting API's Commitment                                                                  

                                 Petitions For Naomi And Linda.                                                        



                                 Like the United States Supreme Court, we have characterized involuntary                                                                                



commitment for a mental illness as a "massive curtailment of liberty" that demands due                                                                                                                      

process of law.                      62  

                                                                                                                                                                                                                

                                           We have also recognized that constitutional rights "extend 'equally to  



                                                                                                                                                                                                                

mentally ill persons' so that the mentally ill are not treated 'as persons of lesser status or  



                                                                                    63  

                                                                                                                                                                                                   

dignity because of their illness.' "                                                       Under both the U.S. Constitution and the Alaska  



                                                                                                                                                                                               64  

                                                                                                                                                                                                              

Constitution, no person may be deprived of liberty without due process of law,                                                                                                                      but we  



                                                                                                                                                                                                       

have  "declared  Alaska's  constitutional  guarantee  of  individual  liberty  to  be  more  



                                                                                                   65  

                                                                                                                                                                                                              

protective" than its federal counterpart.                                                                   But when a person has been found to be  



                                                                                                                                                                                                                 

gravely disabled, as Naomi has been, the State's power of parens patriae  authorizes it  



                                                                                                      66  

                                                                             

to commit her for involuntary treatment.                                                                                                                                                              

                                                                                                              Similarly, when a person has been found  



                 62              Wetherhorn v. Alaska Psychiatric Inst.                                                            , 156 P.3d 371, 375-76 (Alaska            



2007) (first quoting                            Humphrey v. Cady                              , 405 U.S. 504, 509 (1972); then citing                                                      Addington  

v.  Texas, 441 U.S. 418, 425 (1979)).                                 



                 63              See Myers v. Alaska Psychiatric Inst., 138 P.3d 238, 248 (Alaska 2006)  

                                                                                                                                                                                                      

(quoting Rivers v. Katz, 495 N.E.2d 337, 341 (N.Y. 1986)).  

                                                                                                                                 



                 64	             U.S. Const. amend. XIV,  1; Alaska Const. art. I,  7.  

                                                                                                                                                                 



                 65              Myers, 138 P.3d at 245 (citing Breese v. Smith, 501 P.2d 159, 170 (Alaska  

                                                                                                                                                                                                  

 1972)).  



                 66              E.P. v. Alaska Psychiatric Inst., 205 P.3d 1101, 1108 n.24 (citing Rust v.  

                                                                                                                                                                                                    

State, 582 P.2d 134, 139 n.16 (Alaska 1978)); see also Myers, 138 P.3d at 249 ("The  

                                                                                                                                                                                                      

doctrine of parens patriae  refers to the inherent power and authority of the state to  

                                                                                                                                                                                                               

                                                                                                                                                                                    (continued...)  



                                                                                                     -24-	                                                                                              7328
  


----------------------- Page 25-----------------------

likely to cause harm to others, as Linda has been, the State has a compelling interest in                                                                                



                                                                                                      67  

protecting the public, grounded in its police power.                                                       



                                                                                                                                                                          

                           1.	          The superior court's finding that Naomi was gravely disabled is  

                                                                

                                        not clearly erroneous.  



                                                                                                                                                               

                           A court may issue an order committing an individual to a treatment facility  



                                                                                                                                                                      

for  a  30-day  period  only  if  it  "finds,  by  clear  and  convincing  evidence,  that  the  



                                                                                                                                                                         

 [individual] is mentally ill and as a result is likely to cause harm to [herself] or others or  



                                          68  

                                                                                                                                                                        

is gravely disabled."                           Alaska Statute 47.30.915(9) defines "gravely disabled" as "a  



                                                                                                                   

condition in which a person as a result of mental illness" either:  



                                                                                                                                         

                                        (A) is in danger of physical harm arising from such  

                                                                                                                                              

                           complete neglect of basic needs for food, clothing, shelter, or  

                                                                                                                                        

                           personal safety as to render serious accident, illness, or death  

                                                                                                                               

                           highly probable if care by another is not taken; or  



                                                                                                                                      

                                        (B) will, if not treated, suffer or continue to suffer  

                                                                                                                                  

                           severe and abnormal mental, emotional, or physical distress,  

                                                                                                                                              

                           and this distress is associated with significant impairment of  

                                                                                                                          

                          judgment,               reason,            or      behavior             causing            a      substantial  



              66           (...continued)  



                                                                                                                                                                           

protect 'the person and property' of an individual who 'lack[s] legal age or capacity.' "  

                                                                                                                                                                 

(alteration in original) (first quoting Pub. Defender Agency v. Superior Court, Third  

                                                                                                                                                             LACK 'S  

Judicial Dist., 534 P.2d 947, 949 (Alaska 1975); and then quoting non sui juris, B 

LAW  DICTIONARY  (8th ed. 2004))).                     



              67           See Wetherhorn, 156 P.3d at 376 n.13 ("A person who presents a danger   



to others is committed under the state's police power.                                                      A person who requires care and                           

treatment is committed through exercise of the state's parens patriae power.  One who  

                                                                                                                                                                    

poses a danger to himself is committed under a combination of both powers."                                                                                (quoting  

Rust v. State            , 582 P.2d 134, 139 n.16 (Alaska 1978)));                                           see also Myers                , 138 P.3d at 248         

(noting that "the state's power of civil commitment sufficed to meet its police-power  

                                                                                                                                                  

interest" in protecting the public and the patient from the danger posed to herself or  

                                                                                                                                                                        

others).  



              68           AS 47.30.735(c).  

                                   



                                                                                  -25-	                                                                           7328
  


----------------------- Page 26-----------------------

                          deterioration   of   the   person's   previous   ability   to   function  

                          independently.  



                          We have noted that "[i]t is not enough to show that care and treatment of                                                                  



an individual's mental illness would be preferred or beneficial or even in [that person's]                                                             

                              69       Instead,  for  a  court  to  properly  commit  an  individual  under  

best   interests."                                                                                                                                          



AS 47.30.915(9)(B), there must be "a level of incapacity that prevents the person in  

                                                                                                                                                                     

question from being able to live safely outside of a controlled environment."70   The level  

                                                                                                                                                                



of incapacity must be severe enough to "justify the social stigma that affects the social  

                                                                                                                                                             



position and job prospects of persons who have been committed because of mental  

                                                                                                                                                           

illness."71  



                          Naomi  argues  that  the  evidence  presented  to  the  superior  court  was  

                                                                                                                                                                



insufficient to support a finding that she was gravely disabled.   She asserts that the  

                                                                                                                                                         



court's reliance on Dr. Mack's testimony was misplaced because his testimony about her  

                                                                                                                                                                   



housing situation  was "speculative," and that other evidence of her risk of harm if  

                                                                                                                                                                     



released from API was "weak."  She further argues that her willingness to remain in the  

                                                                                                                                                                   



hospital  suggested  a  level  of  amenability  to  treatment  that  brought  her  outside  the  

                                                                                                                                                                  



statutory definition of "gravely disabled."  Naomi's arguments lack merit.  

                                                                                                                                                  



                          Dr. Mack's uncontrovertedtestimonywasthatNaomididnot havehousing,  

                                                                                                                                                         



that Naomi's disorder was severe enough that she could not be expected to find housing  

                                                                                                                                                          



on her own, and that she may not have been able to eat and shower regularly unless API  

                                                                                                                                                                 



             69            Wetherhorn v. Alaska Psychiatric Inst.                                    , 156 P.3d 371, 378 (Alaska 2007)                       



(first alteration in original) (quoting                               In re LaBelle             , 728 P.2d 138, 146 (Wash. 1986) (en                               

banc)).  



             70           In reStephen O., 314 P.3d 1185, 1193 (Alaska 2013) (quoting Wetherhorn,  

                                                                                                                                                 

 156 P.3d at 378).  

                                    



             71            Wetherhorn, 156 P.3d at 378.  

                                                                                     



                                                                                -26-                                                                           7328
  


----------------------- Page 27-----------------------

provided her those amenities.                                                                                                                                                  Naomi acknowledged that she was unable to engage in                                                                                                                                                                                                                                                                          



 discharge   planning   because   "[s]he   talked   over  the   doctors   or   others   trying   to  



 communicate with her" and "sometimes continued shouting even after returning to her                                                                                                                                                                                                                                                                                                                                                                                                                



 own room."                                                             The superior court found that Naomi's delusions of rape and bodily harm                                                                                                                                                                                                                                                                                                                                                                               



 and that her psychiatric status had become "more acute" during the time that she refused                                                                                                                                                                                                                                                                                                                                                                                    



to take medication or to participate in planning her treatment.                                                                                                                                                                                                                                           



                                                                              Naomi points to nothing in the record contradicting Dr. Mack's testimony.                                                                                                                                                                                                                                                                                                                                                                       



Naomi's attorney asked no questions of Dr. Mack and presented no countervailing                                                                                                                                                                                                                                                                                                                                                  



 evidence to the court.                                                                                                        Dr. Mack's testimony supports the court's finding that clear and                                                                                                                                                                                                                                                                                                   



 convincing evidence showed Naomi to be gravely disabled.  The court did not specify                                                                                                                                                                                                                    



whether    it    found    Naomi    gravely    disabled    under    subsection    (A)    or    (B)    of  



AS 47.30.915(9); we conclude that the court did not err in issuing the commitment order                                                                                                                                                                                                                                                                                                                                                                                                  



because uncontroverted evidence supports either or both findings. We affirm the court's                                                                                                                                                                                                                                                                                                                                                                                         



 finding as not clearly erroneous in this case but take this opportunity to remind the                                                                                                                                                                                                                                                                                                                                                                                                              



 superior court of the importance -both for ensuring judicial transparency and for aiding                                                                                                                                                                                                                                                                                                                                                                                           



 appellate review - of specifying                                                                                                                                                                            the precise statutory grounds                                                                                                                                                             on which                                                  it makes   



 findings of grave disability.                                                                        



                                                                              2.	                                    The superior court did not err in determining there was no                                                                                                                                                                                                                                                                                                                       

                                                                                                                     feasible less restrictive alternative to hospitalizing Linda at API.                                                                                                                                                                                                                                                                                                   



                                                                              After a court has found that a person is gravely disabled or poses a danger                                                                                                                                                                                                                                                                                                                



to herself or others, the court must consider whether that person should be involuntarily                                                                                                                                                                                                                                                                                                                                                   



 committed  for  treatment, or whether there is a less restrictive alternative available.                                                                                                                                                                                                                                                                                                                                                                                                                                     



Alaska Statutes 47.30.735(d) and AS 47.30.755(b) authorize commitment only if no                                                                                                                                                                                                                                                                                                                                                                                                                       

 feasible less restrictive alternative treatment is available.                                                                                                                                                                                                                                                                             72  



                                       72                                    In   re Jacob                                                             S.,   384   P.3d 758,                                                                                            768 (Alaska 2016)                                                                                                       (requiring   courts to   



                                                                                                                                                                                                                                                                                                                                                                                                                                            (continued...)  



                                                                                                                                                                                                                                                 -27-	                                                                                                                                                                                                                                                                  7328  


----------------------- Page 28-----------------------

                    "We  determine  the  boundaries  of  individual  rights guaranteed  under  the  



Alaska  Constitution  by  balancing  the  importance  of  the  right  at  issue  against  the  state's  



                                                                      73  

interests   in   imposing   the   disputed   limitation."                    Involuntary   commitment   places   a  



substantial  burden   on   a   fundamental right; accordingly  the   State  must   "   'articulate   a  



compelling  [state]  interest'  and  .  .  .  demonstrate  'the  absence  of  a  less  restrictive  means  

to  advance  [that]  interest.'  "74  

                                            To  that  end,  we  have  concluded  that  "[f]inding  that  no  less  



restrictive       alternative        exists      is    a    constitutional         prerequisite         to    involuntary  

hospitalization."75  



                              a.       A  less  restrictive  alternative  to  involuntary  commitment  

                                       is  not  "feasible"  or  legally  relevant  if  it  does  not  exist.  



                    Linda argues  on  appeal that the superior court erred by rejecting Soteria- 



Alaska  as a     less restrictive  alternative,  and  that  it w            as  therefore  a  violation  of  Linda's  



constitutional  right  to  liberty  to  order  her  committed  to  API.   The  State  posits  that  there  



was no error,   citing   our   statement   in  Bigley   v.  Alaska  Psychiatric  Institute  that   for   a  



program  to  be  considered  a  less  restrictive  alternative,  "the  alternative  must  actually  be  



available,   meaning   that   it   is   feasible   and   would   actually   satisfy   the   compelling   state  



          72        (...continued)  



                                                                                                                        

"consider whether a less restrictive alternative would provide adequate treatment" when  

                                                                                                                       

involuntary commitment is sought); Mark V. II, 375 P.3d 51, 58-59 (Alaska 2016)  

                                                                                                                

(requiring apetitioner seeking involuntary commitment to proveby clear andconvincing  

                                                              

evidence that there are no less restrictive alternatives).  



          73       Myers v. Alaska Psychiatric Inst., 138 P.3d 238, 245 (Alaska 2006).  

                                                                                                               



          74       Id. at 245-46 (alterations in original) (first quoting Ranney v. Whitewater  

                                                                                                               

Eng'g, 122 P.3d 214, 222 (Alaska 2005); then quoting Sampson v. State, 31 P.3d 88, 91  

                                                                                                                            

(Alaska 2001)).  

             



          75       Mark V. II, 375 P.3d at 59.  

                                                       



                                                             -28-                                                       7328
  


----------------------- Page 29-----------------------

                                                                                                                                        76  

interests that justify the proposed state action."                                                                                             Accordingly, the State argues that                                                        



"[b]ecause Soteria-Alaska is closed, it is neither 'available' nor 'feasible' as an option  



for Linda." Linda argues in response that the State reads                                                                                                   Bigley 's feasibility requirement                     



too   narrowly   and   that   "Soteria-Alaska   was   not  infeasible   just   because   it   had   been  



closed." Quoting language from our decision in                                                                                        State v. Alaska Laser Wash, Inc.                                                          , Linda   



asserts   that   "feasible"   means   "[c]apable   of   being   accomplished   or  brought   about;  

                            77       Using that definition, Linda concludes that "Soteria-Alaska was clearly  

possible."                                                                                                                                                                                                                      



feasible because it had operated quite well for seven years."  

                                                                                                                                                     



                                      Linda's argument is not persuasive, as it fails to consider for whom  an  

                                                                                                                                                                                                                                             



alternative is feasible. In essence, Linda's argument is that because it would be possible  

                                                                                                                                                                                                                             



for the State to establish and operate a mental health facility and program similar to  

                                                                                                                                                                                                                                              



 Soteria-Alaska, which was a private facility, the superior court was required to consider  

                                                                                                                                                                                                                            



 Soteria-Alaska a "feasible" less restrictive alternative to hospitalization. But whether or  

                                                                                                                                                                                                                                              



not it might be feasible, possible, or even advisable for the State to establish a facility and  

                                                                                                                                                                                                                                          

                                                                        78   with  or  without  additional  funding  from the  legislature,  

operate  such  a  program,                                                                                                                                                                                          

                                              



committing Linda to Soteria-Alaska or another Soteria-like setting was not an option for  

                                                                                                                                                                                                                                            



                   76                 208 P.3d 168, 185 (Alaska 2009).                                             



                   77                 382   P.3d   1143,   1152   (Alaska   2016)   (alteration   in   original)   (quoting  



Feasible, A                      MERICAN  HERITAGE  DICTIONARY  (5th ed. 2014)).                                                                                             Alaska Laser Wash                                      arose  

from an inverse condemnation claim by a car wash owner; in that case, we decided that                                                                                                                                                     

the "feasibility, rather than reasonableness," of relocating a business "is the correct                                                                                                                                        

 standard for analyzing whether a business owner may recover business-loss damages                                                                                                                                         

when the State condemns the business owner's property."                                                                                                             Id.   The case did not involve                             

the question whether a less restrictive alternative existed to infringing on a persons                                                                                                                                       

constitutional   rights.     Thus,   beyond   providing   a   dictionary   definition   of   the   word  

"feasible," our decision in                                                Alaska Laser Wash                                       is not relevant to the discussion here.                                                                    



                   78                 We draw no conclusions and express no opinion on whether this is the case.  

                                                                                                                                                                                                                                       



                                                                                                                    -29-                                                                                                              7328
  


----------------------- Page 30-----------------------

the superior court. The court was faced with the question what to do about Linda, whom                                                                                                                                                 



the jury had found to be mentally ill and a danger to others; the court needed to answer                                                                                                                                             



that question with one of the options actually available to it at the time of the hearing.                                                                                                                                                                  

                                                                                                                                                                                                               79  and sending  

Because Soteria-Alaska was closed, it was not "actually . . . available,"                                                                                                                                            



Linda there was not feasible.  The State had no duty to re-open the private facility or to  

                                                                                                                                                                                                                                                   



establish and operate a similar facility to meet its burden in this case.  

                                                                                                                                                                                        



                                                          b.	                The superior court did not clearly err in finding that no  

                                                                                                                                                                                                                                                 

                                                                             less restrictive alternative existed.  

                                                                                                                                                                                      



                                       Whether or not Linda's proposed alternative - Soteria-Alaska - was  

                                                                                                                                                                                                                                                            



feasible, the State had the burden to show by clear and convincing evidence that no less  

                                                                                                                                                                                                                                              

restrictive alternative to commitment existed.80  

                                                                                                                                                                                                                                     

                                                                                                                                        To that end, the parties explored several  



                                                                                                                                                                                                                                      

possible  alternatives,  including  outpatient  community  support  and  assisted  living  



                                                                                                                                                                                                                                                

facilities.  The superior court found that a viable alternative would need to "protect the  



                                                                                                                                                                                                                                                 

public from the harm of delusions where [Linda] might believe she's being chased by  



                                                                                                                                                                                                                                        

others and cause traffic accidents" or might "react[] in a physical manner." It also found  



                                                                                                                                                                                                                                            

that when Linda becomes agitated, it happens rapidly, which "could cause others to react  



                                                                                                                                                                                                                           

to her [and cause] her to take actions that pose risks to the public." The court concluded  



                   79                 Bigley, 208 P.3d at 185.                                                    The issue raised in                                         Bigley   - whether a less                                      



intrusive alternative to psychotropic medication was available - is not identical to the                                                                                                                                                        

issue   Linda   raises   here:     whether   a   less   restrictive   treatment   than   commitment  is  

available.   See id.                              at 185-86. But because both inquiries balance "the fundamental liberty                                                                                                              

and privacy interests of the patient against the compelling state interest[s]" of protecting                                                                                                                                

disabled individuals and the public, and because both require a finding that no less                                                                                                                                                         

intrusive or less restrictive alternative exists, the court must perform substantially the                                                                                                                                                      

 same feasibility analysis in each case.                                                                       Id.  at 185;                    see Mark V. II                            , 375 P.3d at 59.                     



                   80                 Mark V. II, 375 P.3d at 58. Evidence is clear and convincing if it "produces  

                                                                                                                                                                                                                       

in the trier of fact a firm belief or conviction about the existence of a fact to be proved."  

                                                                                                                                                                                                                                                            

Bigley, 208 P.3d at 187 (quoting Buster v. Gale, 866 P.2d 837, 844 (Alaska 1994)).  

                                                                                                                                                                                                                            



                                                                                                                       -30-	                                                                                                               7328
  


----------------------- Page 31-----------------------

that none of the proposed less restrictive alternatives would protect the public "from the                                                                                                    



danger to others that [Linda] currently [poses]," and that Linda needed "a facility like                                                                                                    

API that is locked and . . . provides 24/7 care."                                                         81  



                                                                                                                                                                                              

                               In short, we find no clear error in the superior court's finding that no  



                                                                                                                                                                                             

 feasible less restrictive alternative to involuntarily committing Linda to API existed. We  



                                                                                                                                             

therefore affirm the superior court's commitment order in her case.  



                                                                                                                                                     

                C.	            The  Superior  Court  Did  Not  Err  In  Granting  API's  Involuntary  

                                                                                          

                              Medication Petition For Naomi.  



                                                                                                                                                                                         

                              After a court has ordered an individual involuntarily committed, the State  



                                                                                                                                                                                             

may forcibly administer psychotropic medication in a non-crisis situation only if the  



                                                                                                                                                                                

individual "is determined by a court to lack the capacity to give [or withhold] informed  



                                                                                                                                                                          

consent"  to  the  medication,  and  the  State  demonstrates  "by  clear  and  convincing  



                                                                                                                                                                                           

evidence that the involuntary administration of psychotropic medication is in the best  



                                                                                                                                                                                                82  

                                                                                                                                                                                                      

interests of the patient and that no less intrusive alternative treatment is available." 



Naomi asks us to vacate the involuntary medication order in her case, arguing that the  

                                                                                                                                                                                             



 superior court erred in finding that administration of medication was in her best interests  

                                                                                                                                                                                  



and in finding that there was no less intrusive alternative.  Both claims rely on already- 

                                                                                                                                                                                 



rejected interpretations of applicable law.  

                                                                                     



               81             Linda has not challenged the court's finding that the State's interest in                                                                                        



protecting the public required placing her in a locked facility with 24/7 care.                                                                                    



               82             Bigley, 208 P.3d at 179-80 (first citing AS 47.30.836; then citing Myers v.  

                                                                                                                                                                                                

Alaska Psychiatric Inst. , 138 P.3d 238, 249-50 (Alaska 2006)).  

                                                                                                                                                 



                                                                                              -31-	                                                                                      7328
  


----------------------- Page 32-----------------------

                                1.	            The superior court did not err in its consideration of the best                                                                                   

                                               interests factors.   



                               In   Myers   v.   Alaska   Psychiatric   Institute   we   drew   upon   the   statutory  



framework for informed consent to the administration of psychotropic medication to                                                                                                                          



articulate factors that a court must consider in making a best interests determination for                                                                                                          

the involuntary administration of psychotropic drugs:                                                                         83  



                                                                                                                                                                  

                                               (A)  an  explanation  of  the  patient's  diagnosis  and  

                                                                                                                                                          

                               prognosis, or their predominant symptoms, with and without  

                                        

                               the medication;  



                                                                                                                                                                     

                                               (B)  information  about the proposed  medication,  its  

                                                                                                                                           

                               purpose, the method of its administration, the recommended  

                                                                                                                                                                       

                               ranges of dosages, possible side effects and benefits, ways to  

                                                                                                                                                                      

                               treat  side  effects,  and  risks  of  other  conditions,  such  as  

                                                 

                               tardive dyskinesia;  



                                                                                                                                                   

                                               (C)  a  review  of  the  patient's  history,  including  

                                                                                                                                                 

                               medicationhistory and previous sideeffectsfrommedication;  



                                                                                                                                                             

                                               (D) an explanation of interactions with other drugs,  

                                                                                                                                                         

                               including over-the-counter drugs, street drugs, and alcohol;  

                                          

                               and  



                                                                                                                                                                 

                                               (E) information about alternative treatments and their  

                                                                                                                                                                     

                               risks,  side  effects,  and  benefits,  including  the  risks  of  

                               nontreatment.[84]  



                83              138 P.3d at 252 (directing courts to apply AS 47.30.837(d)(2)'s informed                                                                              



consent factors to the best interests determination).                                                                    



                84             Id. (quoting AS 47.30.837(d)(2)).  

                                                                      



                                                                                                 -32-	                                                                                         7328
  


----------------------- Page 33-----------------------

                                                                                                                                                     85  

We stated that these factors are "crucial in establishing the patient's best interests,"                                                                 and  



                                                                                                                                                             86  

we further explained in                    Bigley  that "their consideration by the trial court is mandatory."                                                   



                                                               87  

We call these the "Myers factors."                                   

                                                



                                                                                                                                                  

                         But Myers also discussed a second set of best interests principles derived  



                                                                

from a Minnesota Supreme Court decision:  



                                                                                                                       

                                     (1)  the  extent and  duration  of changes in  behavior  

                                                                                                          

                        patterns and mental activity effected by the treatment;  



                                                                                          

                                     (2) the risks of adverse side effects;  



                                                                                                     

                                     (3) the experimental nature of the treatment;  



                                                                                                                                  

                                     (4) its acceptance by the medical community of the  

                                            

                         state; and  



                                     (5) the extent of intrusion into the patient's body and  

                                                                                               [88]  

                                                                             

                         the pain connected with the treatment. 

We refer to them as the "Minnesota factors"89  and explained in Bigley that "to the extent  

                                                                                                                                                     



they differ from the Myers factors, their consideration by Alaskan courts is favored but  

                                                                                                                                                          

not mandatory."90  

        



                        Naomi concedes that thesuperior court assessedthepetitionfor involuntary  

                                                                                                                                           



administration of medication according to the mandatory Myers factors. She argues that  

                                                                                                                                                         



the court nonetheless erred because In re Gabriel C.  requires the court to apply the  

                                                                                                                                              



            85          Id. ;  accord Bigley              , 208 P.3d at 180.
         



            86           208 P.3d at 180.
               



            87          Id.
  



            88           138 P.3d at 252 (citing Price v. Sheppard, 239 N.W.2d 905, 913 (Minn.  

                                                                                                                                                   

 1976)).  



            89          Bigley, 208 P.3d at 180.  

                                                             



            90          Id. at 180-81.  

                                                   



                                                                            -33-                                                                      7328
  


----------------------- Page 34-----------------------

                                                      91  

 Minnesota factors to its analysis.                        While our opinion in that case does refer to the                        



                                                                           92  

 Minnesota   factors   in   its   discussion   of   Myers,                                                                         

                                                                               it  misquoted  Myers  as  making  the  



                                                                                                                                     

 Minnesota factors mandatory and does not alter the analytical framework established by  



                                                                                                                                  

Myers  and  Bigley.               We  reiterate  that  the  Minnesota  factors  offer  "  'helpful'  and  



                                                                                                                                   

 'sensible' "guidance in determining whetherinvoluntary medication is inapatient's best  

                                                                                                      93  The superior court,  

                                                                                                                                

 interests, but they are not a mandatory component of the analysis. 



therefore,  did  not err  by  not considering  the Minnesota factors in  its best interests  

                                                                                                                           



 determination.  



                     2.	        The superior court did not err in determining that there was no  

                                                                                                                                     

                                less intrusive alternative to medication.  

                                                                               



                     In order to administer psychotropic medication without a patient's consent,  

                                                                                                                            



the State must also  show by  clear  and  convincing  evidence "that no  less intrusive  

                                                                                                                          

 alternative treatment is available."94  

                                                                                                                        

                                                            Determining whether a less intrusive alternative  



                                                                                                                                   

 exists involves both "a balancing of legal rights and interests" and a factual inquiry into  

                                    95    The  legal  balancing  weighs  "the  fundamental  liberty  and  

                                                                                                                                  

 alternative  treatments. 



privacy interests of the patient against the compelling state interest under its parens  

                                                                                                                              



patriae authority to 'protect "the person and property" of an individual who lack[s] legal  

                                                                                                                                 



           91        324  P.3d  835,  840  (Alaska  2014).  



           92        Id.  



           93        Bigley,  208  P.3d  at  180-81  (quoting  Myers,  138  P.3d  at  252).   We  disavow  



 any  erroneous  statements  to  the  contrary.   Cf.  In  re  Jacob  S.,  384  P.3d  758,  772  (Alaska  

 2016);  Gabriel  C.,  324  P.3d  at  840.  



           94        Bigley, 208 P.3d at 180.  

                                                             



           95        Id. at 185.  

                               



                                                                 -34-	                                                          7328
  


----------------------- Page 35-----------------------

                                 96  

age or capacity.' "                   This is interwined with the factual assessment of "the feasibility and                                               



                                                                                      97  

likely effectiveness of a proposed alternative."                                                                                                   

                                                                                          A proposed alternative "must actually  



                                                                                                                                                         

be available, meaning that it is feasible and would actually satisfy the compelling state  



                                                                                       98  

                                                                         

interests that justify the proposed state action." 



                         Naomi argues that our opinion in Bigley  obligates the superior court to  

                                                                                                                                                             



"weigh the liberty interests of the patient and the feasibility of alternative treatments  

                                                                                                                                             



expressly in its findings" and that it was error not to do so.  She cites Bigley 's direction  

                                                                                                                                                 



that courts "must balance the fundamental liberty and privacy interests of the patient  

                                                                                                                                                    

against the compelling state interest."99   The State argues that Bigley 's directive does not  

                                                                                                                                                           



require  the  trial  court  to  weigh  these  factors  expressly,  but  rather  reiterates  the  

                                                                                                                                                          



overarching principle articulated in Myers that "[w]hen no emergency exists . . . the state  

                                                                                                                                                         



may override a mental patient's right to refuse psychotropic medication only when  

                                                                                                                                                      



necessary to advance a compelling state interest and only if no less intrusive alternative  

                                                                                                                                              

              100   We agree with the State in observing that in Bigley we did not ask trial courts  

exists."                                                                                                                                              



to expressly weigh the patient's liberty and privacy interests against the State interest in  

                                                                                                                                                              



administering  the  medication.                                  Rather,  the  balancing  of  these  two  interests  is  

                                                                                                                                                            



encompassed in the less intrusive alternative inquiry, which requires courts to consider  

                                                                                                                                                 



both  the  availability  of  alternatives  to  medication  and  the  feasibility  of  those  

                                                                                                                                                      



            96           Id.   (alteration in original) (quoting                           Myers, 138 P.3d at 249).
                       



            97           Id.
  



            98           Id.
  

                                



            99           Id.
  



             100         Myers, 138 P.3d at 248.
             



                                                                            -35-                                                                       7328
  


----------------------- Page 36-----------------------

                   101  

alternatives.             The   superior   court   therefore   did   not   err   in   not   explicitly   weighing  



Naomi's   liberty   and   privacy   interests   against   the   State's   interest   in   administering  

medication.102  



                                                                                                                                 

                     Naomi also argues that the evidence considered by the superior court was  



                                                                                                                                   

insufficient to establish that there was no less intrusive alternative to medication.  In  



                                                                                                                               

determining that there existed no less intrusive alternative to forced medication, the court  



                                                                                                                                   

found that "[w]ithout the administration of the medication at issue there would be no  



                                                                                                                                  

improvementbutonly further decompensation as to [Naomi's]mental functioning." The  



                                                                                                                                   

court heard testimony that Naomi's mental health had worsened during the period in  



                                                                                                                           

which she refused to take medication.  And it credited Dr. Mack's testimony that the  



                                                                                                                     

medication was needed because Naomi could not benefit from less intrusive alternatives  



                                                                                                                          

without it:  "[A]ll present paradigm psychiatric literature," Dr. Mack testified, "reflects  



                                                                                                                           

[that medications] are the absolute cornerstone and foundation to success."   Naomi  



                                                                                                                                    

correctly observes that "[w]hile the doctor's perspective [on this issue] is relevant, it is  



                                                                                                                      

not dispositive," but Naomi neither challenged Dr. Mack's perspective at the evidentiary  



                                                                                                                                

hearing nor proposed any alternatives to medication - feasible or otherwise.   The  



                                                                                                                                 

superior court was entitled to rely on Dr. Mack's analysis in reaching its conclusion, and  



                                                                                                                                   

it  was  not  clearly  erroneous  to  find  that  there  was  no  less  intrusive  alternative  to  



medication.  



          101        Bigley, 208 P.3d at 185.         



          102        Cf. Kiva O. v. State, Dep't of Health & Soc. Servs., Office of Children's  

                                                                                                                      

Servs., 408 P.3d 1181, 1190 (Alaska 2018) (holding that "Myers requires only that the  

                                                                                                                                  

court consider the relevant factors; it does not dictate the weight the court gives them").  

                                                                                                                           



                                                                -36-                                                          7328
  


----------------------- Page 37-----------------------

                                     

V.        CONCLUSION  



                                                                                                                           

                    We  hold  that  all  appeals  from  orders  for  involuntary  admission  for  



                                                                                                                    

treatment  and  involuntary  medication  categorically  fall  under  the  public  interest  



                                                                                                                          

exception to the mootness doctrine.  We therefore consider the merits of  Linda's and  



                                                                                                                                 

Naomi's appeals.  We AFFIRM the superior court's commitment order in Linda's case  



because the superior court did not clearly err in finding that no feasible less restrictive  



                                                                                                                    

alternatives to commitmentexisted. Wealso AFFIRMthecommitment orderinNaomi's  



                                                                                                  

case because the superior court did not clearly err in finding that Naomi was gravely  



                                                                                                                           

disabled.   And because we discern no  error in the superior court's issuance of the  



                                                                                                                 

medication order in Naomi's case, we AFFIRM the involuntary medication order.  



                                                             -37-                                                       7328
  


----------------------- Page 38-----------------------

 BOLGER, Justice, concurring.                           



                                       I agree with the court's ultimate conclusion that the mootness doctrine does                                                                                                                          



 not apply to these cases.  But I would reach this conclusion on different grounds.  The                                                     



 court's reliance on the public interest exception to the mootness doctrine is misplaced.                                                                                                                                                                    



 The court concludes that every commitment case involves important issues that are                                                                                                                                                              



 capable of repetition because "an opinion considering whether a commitment order in                                                                                                       



 one case was supported by sufficient evidence will likely be useful as guidance by                                                                                                                                                               

                                                                                                                               1  But as we have recognized, this reasoning  

 analogy to future commitment proceedings."                                                                                                                                                                                   

 could justify review of "every moot case in general."2  

                                                                                                                                                                                                              

                                                                                                                                                                I am concerned that our review  



                                                                                                                                                                                                                                                 

 of such routine controversies on public interest grounds will undermine the basis for the  



                                            

 public interest exception.  



                                                                                                                                                                                                                                                

                                       We decline to address moot controversies because "the very nature of our  



                                                                                                                                                                                                                                 

judicial systemrenders it incapable of resolving abstract questions or of issuing advisory  

                                                                                                                                     3    If the controversy is moot, the litigants  

                                                                                                                                                                                                                                   

 opinions which can be of any genuine value." 

 have less incentive to make their best arguments.4                                                                                                    And regardless of the arguments'  

                                                                                                                                                                                                                         



 quality, we will "lay down rules that may be of vital interest to persons" who will face  

                                                                                                                                                                                                                                 



 future proceedings - this is "a harsh rule" for future litigants, who will be bound by  

                                                                                                                                                                                                                                                  



                    1                  Supra  page   19.  



                    2                  In  re  Gabriel  C.,  324  P.3d  835,  840  (Alaska  2014).   



                    3                  Moore  v.  State,  553  P.2d  8,  23  n.25 (Alaska   1976),  superseded  on  other  



grounds  by  statute.  



                    4                  State  v.  Keep,  409  P.2d   321,   325   (Alaska   1965)   (citing   United  States  v.  



Evans,  213  U.S.  297,  300  (1909)).  



                                                                                                                       -38-                                                                                                                 7328
  


----------------------- Page 39-----------------------

decisions where opposing views were not vigorously presented because the controversy                                         

was moot.        5  



                       The collateral consequences doctrine, in contrast, "allows courts to decide  

                                                                                                                                      



otherwise-moot cases when a judgment may carry indirect consequences in addition to  

                                                                                                                                             

its direct force."6   Several years ago we recognized that the collateral consequences from  

                                                                                                                                         



a person's first involuntary commitment order were sufficient to require review of an  

                                                                                                                                            

otherwise-moot appeal.7  But we later decided that the collateral consequences exception  

                                                                                                                                 



did not apply to a respondent who had previous commitment orders because we were  

                                                                                                                                        



"unconvinced  that  the  mere  possibility  of  additional  but  unparticularized  collateral  

                                                                                                                                



consequences automaticallyjustifiessubstantivereviewofeverysubsequentinvoluntary  

                                                                                                                              

commitment order entered against a respondent."8  

                                                              



                      I disagree with the latter proposition.  There is no evidence that a previous  

                                                                                                                                  



commitment  order  inoculates  the  respondent  from  the  general  consequences  of  a  

                                                                                                                                              



 subsequent commitment; I would not require any additional showing to allow review.  

                                                                                                                                                  



We do not require such a showing in the criminal law; instead we decide criminal cases  

                                                                                                                                        



even  after  defendants  complete  their  sentences  because  we  assume  that  a  criminal  

                                                                                                                                  

judgment always carries collateral consequences. 9                                     Many other state courts similarly  

                                                                                                                                 



           5          Id.  (quoting  Evans,  213  U.S.  at  300).  



           6          In re  Joan  K.,  273  P.3d  594,  597-98  (Alaska  2012)  (quoting  Peter A. v.  



State,  Dep't  of  Health  &  Soc.  Servs.,  Office  of  Children's  Servs.,   146  P.3d  991,  994-95  

(Alaska  2006)).  



           7          Id. at 598.  

                                 



           8          In re Mark  V., 324 P.3d 840, 845 (Alaska 2014).  

                                                                                             



           9          See  State  v.  Carlin,  249  P.3d  752,  764  (Alaska  2011)  (holding  that  a  

                                                                                                                                              

deceased defendant's appeal was not moot).  

                                                               



                                                                     -39-                                                              7328
  


----------------------- Page 40-----------------------

                                                                                                                                                                                                                                                                                                                                     10  

 allow review of expired involuntary commitment orders.                                                                                                                                                                                                                                                                                        I would review these orders                                                                                                   



because they have continuing collateral consequences.                                                                                                                                                                                 



                                       10                                    See In re Walter R                                                                                       ., 850 A.2d 346, 350 (Me. 2004) (holding that collateral                                                                                                                                                                                                              



 consequences ofan involuntary                                                                                                                                                     commitmentorderprecludedapplicationofthemootness                                                                                                                                                                                                                         

 doctrine);   State v. K.J.B.                                                                                                                     , 416 P.3d 291, 298 (Or. 2018) (denying motion to dismiss                                                                                                                                                                                                                                                         

 appeal because state had not shown the absence of collateral consequences);                                                                                                                                                                                                                                                                                                                                                                                       State v.   

K.E.W., 315 S.W.3d 16, 20 (Tex. 2010) (holding that the mootness doctrine did not apply                                                                                                                                                                                                                                                                                                                                                                                           

 to an expired involuntary commitment order);                                                                                                                                                                                                                             State v. J.S.                                                        , 817 A.2d 53, 56 (Vt. 2002)                                                                                                    

 (recognizing the continuing effects of negative collateral consequences, including legal                                                                                                                                                                                                                                                                                                                                                                                            

 disabilities and social stigma, from being adjudicated mentally ill and then involuntarily                                                                                                                                                                                                                                                                                                                                            

hospitalized);  In re Det. of H.N.                                                                                                                                                              , 355 P.3d 294, 298 (Wash. App. 2015) (permitting                                                                                                                                                                                              

review of expired involuntary commitment order due to likely collateral consequences).                                                                                                                                                                                                                                                                                                                                   



                                                                                                                                                                                                                                              -40-                                                                                                                                                                                                                                    7328
  

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