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You can search the entire site. or go to the recent opinions, or the chronological or subject indices. In the Matter of the Necessity for the Hospitalization of G.L. (9/27/2019) sp-7412

In the Matter of the Necessity for the Hospitalization of G.L. (9/27/2019) sp-7412

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

          Readers are requested to bring errors to the attention of the Clerk of the Appellate Courts,  

           303 K Street, Anchorage, Alaska 99501, phone (907) 264-0608, fax (907) 264-0878, email  


                      THE SUPREME COURT OF THE STATE OF ALASKA                                      

In  the  Matter  of  the  Necessity  for  the                        )  

Hospitalization  of                                                  )    Supreme  Court  No.  S-16928  



                                                                     )    Superior Court No. 3AN-17-00779 PR  



                                                                     )    O P I N I O N  



                                                                     )   No. 7412 - September 27, 2019  


                     Appeal from the Superior Court of the State of Alaska, Third  


                     Judicial District, Anchorage, Erin B. Marston, Judge.  


                     Appearances:  Megan R. Webb, Assistant Public Defender,  


                     and Beth Goldstein, Acting Public Defender, Anchorage, for  


                     G.L.       Kimberly  D.  Rodgers,  Assistant  Attorney  General,  


                     Anchorage,  and  Kevin  G.  Clarkson,  Attorney  General,  


                     Juneau, for State of Alaska.  


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


                     and Carney, Justices.  


                     WINFREE, Justice.  



                     A patient appeals a 180-day involuntary commitment order, arguing that  


the evidence presented at the commitment hearing was outdated and insufficient to  


support concluding that he continued posing a risk of harm to others.   Because the  


superior  court  correctly  applied  the  involuntary  commitment  statute  in  this  case,  


appropriately  considering  the  patient's  recent  history  of  conduct  and  demonstrated  


unwillingness to comply with treatment, we affirm the commitment order.  

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

II.           FACTS AND PROCEEDINGS           

              A.            Facts Leading To Involuntary Commitment                               

                            In   2015 then-21-year-old G.L. was arrested after allegedly firing a loaded                                                                

shotgun at buildings and people in his village.                                                   1  G.L. faced criminal charges related to  


the  shooting,  but  the  superior  court  ultimately  ruled  him mentally  incompetent  for  


criminal proceedings and in 2016 committed him to Alaska Psychiatric Institute (API)  


for competence restoration.  


                            G.L. was diagnosed with schizophrenia.  He refused to consistently take  


medications and "was becoming increasingly psychotic and paranoid and dangerous"  


while at API for competence restoration.  His API psychiatrist later testified that G.L.  


experienced "somatic delusions," meaning he "believe[d] that things [were] happening  


to his body that [weren't] real."  He believed, for example, that rats had infiltrated his  


body, that his "bones were melting," and that "ants [were] crawling on his eyes."  The  


psychiatrist stated that G.L. also suffered from "persecutory delusions," meaning "he  


[felt] that people [were] saying things about him that [were] untrue," including that he  


hadbeen diagnosed with schizophrenia. G.L.reportedly "pace[d]thehallways muttering  


under his breath" and "bec[a]me increasingly violent"; he kicked inanimate objects,  


charged at staff, and expressed suicidal and homicidal ideation. The psychiatrist testified  


that G.L. "had such profound psychiatric symptoms that they were interfering with his  


ability to participate in any competency restoration activities."  


                            API petitioned the superior court for permission to involuntarily medicate  


G.L., but the court instead transferred G.L.'s custody to the Department of Corrections  


(DOC).               While in DOC custody  he apparently "head-butted a corrections officer."  

              1             Although we typically use pseudonyms to protect parties' privacy, we refer                                                                        

to the patient in this case by his initials in response to his request, "[b]ecause the use of                                                                                      

pseudonyms can be confusing for an individual diagnosed with schizophrenia."                                                                                              

                                                                                         -2-                                                                                 7412

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

 G.L.'s pending criminal charges were dismissed thereafter, and he was transferred back                                                                                                                                                                                                                                                                                                                                                                                     

to API in March 2017.                                                                                                              

                                      B.                                   30-Day Commitment And Court-Ordered Medication Petitions                                                                                                                                                                                                                                                                                                                                       

                                                                           API filed a 30-day commitment petition asserting that G.L. had a mental                                                                                                                                                                                                                                                                                                      

illness and was likely to cause harm to himself or others. API stated that he had a history                                                                                                                                                                                                                                                                                                                                                              

 of violence, including the alleged 2015 shooting, and discussed his threats of suicide and                                                                                                                                                                                                                                                                                                                                                                                       

his "assaultive behaviors while at API and DOC in the past 8 months."                                                                                                                                                                                                                                                                                                                                         API also stated                                        

that G.L. "does not believe he has a mental illness and . . . does not intend to take                                                                                                                                                                                                                                                                                                                                                                                        

medications once he leaves the hospital."                                                                                                                                                                                                G.L. stipulated to the 30-day commitment in                                                                                                                                                                                                       


                                                                            Three days before the end of                                                                                                                               his 30-day commitment period, API filed                                                                                                                                                                                             a90-  

 day commitment petition.  The 90-day commitment hearing was continued until June,   

 and in the interim API filed a petition for court-ordered administration of psychotropic                                                                                                                                                                                                                                                                                                                                    

medications. G.L. had been taking medications since being in DOC custody, but his API                                                                                                                                                                                                                                                                                                                                                                                           

psychiatrist later testified that G.L. "had become increasingly vocal about his . . . wish                                                                                                                                                                                                                                                                                                                                                                                 

not to take medications," and in early May he altogether refused to take medications.                                                                                                                                                                                                                                                                                                                                                                                                                    

The   medications  were   discontinued   because   of   adverse   effects   associated   with  

intermittent   use.     The   psychiatrist   later   stated   that   G.L.'s   somatic   and   persecutory  

 delusions returned while he was off medications and that he had become "increasingly                                                                                                                                                                                                                                                                                                                                      

 symptomatic," including trying to assault an API staff member and exhibiting angry                                                                                                                                                                                                                                                                                                                                                                                 


                                                                           Amagistratejudge considered themedication petition inmid-May, hearing                                                                                                                                                                                                                                                                                                             

                                                                                                                                                                                                                                                                                                                                                                               2  and G.L. The court- 

testimony from the API psychiatrist, two court-appointed visitors,                                                                                                                                                                                                                                                                                                                                                                                                   

                                      2                                    When a court considers a petition to authorize psychotropic medication, a                                                                                                                                                                                                                                                                                                                                            

 "visitor" must be appointed to "assist the court."                                                                                                                                                                                                                            AS 47.30.839(d).                                                                                        The visitor's duties                                                         


                                                                                                                                                                                                                                            -3-                                                                                                                                                                                                                             7412

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 appointed visitors offered conflicting testimony whether G.L. had capacity to provide                                                                                                                                                                                                                                                                                                                                         

informed consent. One court-appointed visitor, who had met with G.L. briefly one week                                                                                                                                                                                                                                                                                                                                                        

before the hearing, testified that she believed he had capacity, because he "appear[ed] at                                                                                                                                                                                                                                                                                                                                                                     

that time to demonstrate rational thought process" and "expressed that he had a mental                                                                                                                                                                                                                                                                                                                                        

illness."   But the other court-appointed visitor, who had met with G.L. the morning of                                                                                                                                                                                             

the hearing, believed he lacked capacity, because he failed to "recognize that he has a                                                                                                                                                                                                                                                                                                                                                                           

mental illness" and could not participate in his treatment.                                                                                                                                                                                                                                                  This second court-appointed                                            

visitor also testified that G.L. had attacked an API staff member just a few days before                                                                                                                                                                                                                                                                                                                                              

the hearing and had been given crisis medications as a result.                                                                                                                                                                                                                                                                       

                                                                       TheAPI psychiatrist                                                                                        testifiedaboutG.L.'shistoryand unwillingness                                                                                                                                                                                                        to take  

medications.     She   stated   that   during   a   previous   API   admission,   he   had   refused   to  

voluntarily take medications.                                                                                                                                And although he had willingly taken medications when                                                                                                                                                                                                                          

he arrived at API most recently, the psychiatrist stated that G.L. "did not feel he really                                                                                                                                                                                                                              

needed them" and continually stated that "he did not plan to take them when he left the                                                                                                                                                                                                                                                                                                                                                                

hospital." She testified that his stance remained the same on the morning of the hearing.                                                                                                                                                                                                                                                                                                                                                                                     

 She stated that without medication, "given [her] experience with him in the past where                                                                                                                                                                                                                                                                                                                                                

he was either engaging in self-destructive behavior or he was assaultive, . . . his behavior                                                                                                                                                                                                                                                                                                                              

is going to continue to deteriorate and . . . we will see those sorts of behaviors again                                                                                                                                                                                                                                                                                                                                                  

necessitating a further crisis period."                                                                                                                                                             

                                                                       G.L.  testified that he did not wish to take medications because he had not                                                                                                                                                                                                                                                                                                    

been medicated before the alleged 2015 shooting events and "didn't need them."                                                                                                                                                                                                                                                                                                                                                                      He  

                                   2                                   (...continued)  


include "gather[ing] and provid[ing] information to the court on . . . a patient's present  


 condition [and] . . . conduct[ing] a search for any prior 'expressed wishes of the patient  


regarding  medication.'  "   Myers v.  Alaska  Psychiatric Inst.,  138  P.3d 238,  243-44  


 (Alaska 2006) (quoting AS 47.30.839(d)).  

                                                                                                                                                                                                                              -4-                                                                                                                                                                                                              7412

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

discussed   what   he   believed   were   the   medications'   adverse   side   effects,   including  

paranoia.   He stated that there were "no benefits" to taking the medications and that he                                                                                                                                                                                                                                                                                                                                               

did not believe he had schizophrenia.                                                                                                                                                           

                                                                   At   the   end   of   the   medication   hearing   the   magistrate   judge   made   oral  

 findings,   based   on   the psychiatrist's and                                                                                                                                                                       G.L.'s testimony,                                                                               that G.L. suffered                                                                                 from  

 schizophrenia    and    lacked    capacity    to    give    informed    consent.      The    magistrate  

recommended granting the medication petition, despite the risks associated with taking                                                                                                                                                                                                                                                                                                                               

psychotropic medications, because G.L. is violent when unmedicated, and the benefits,                                                                                                                                                                                                                                                                                                                    

including protecting others and alleviating some of G.L.'s suffering, outweighed the                                                                                                                                                                                                                                                                                                                                                

risks.    The superior court affirmed the recommendation in a written order later that                                                                                                                                                                                                                                                                                                              


                                  C.                                90-Day Commitment Petition                                                                                                                                       

                                                                   After a June 2017 hearing a magistrate judge recommended denying API's                                                                                                                                                                                                                                                                              

 90-day commitment petition, finding that G.L. suffered frommental illness but that there                                                                                                                                                                                                                                                                                                                                   

was not clear and convincing evidence he posed a risk of harm to himself or others                                                                                                                                                                                                                                                                                                                                  

"while   compliant  with   a   treatment   plan   including   appropriate   medication."     The  

magistrate judge found that G.L.'s sister's home was a viable less restrictive alternative                                                                                                                                                                                                                                                                                                     

placement, so long as he was closely monitored and he strictly complied with prescribed                                                                                                                                                                                                                                                                                                         

medications.   API objected to the magistrate judge's recommendation, and the superior                                                                                                                                                                                                                                                                                                                     

court held a de novo hearing on the 90-day commitment petition in July.                                                                                                                                                                                                                                                                                                           

                                                                    The superior court heard testimony from the API psychiatrist, G.L.'s API                                                                                                                                                                                                                                                                                    

 social worker, and G.L.'s sister.                                                                                                                                The psychiatrist recounted G.L.'s history of assaultive                                                                                                                                                                         

behaviors in and out of API, and she stated that since the court's May 2017 medication                                                                                                                                                                                                                                                                                                      

order, he had taken medications willingly and "he's more calm." She stated that he "still                                                                                                                                                                                                                                                                                                                                   

does not believe that he has a mental illness" nor that he needs medications.                                                                                                                                                                                                                                                                                                                 She stated   

that   since   taking   the   court-ordered   medications,   "he's   done   well   because   he's   on  

                                                                                                                                                                                                                    -5-                                                                                                                                                                                                      7412

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


medications and he's in a really structured environment, and people are supervising him  


24 hours a day."   She explained that the medications are not curative; they simply  


manage symptoms of schizophrenia, and without the medications, he could become  


worse within one week.  She stated that he "still has the same delusions, he just may be  


less preoccupied with them right now, so they don't interfere with his ability to function  


as much."  And she noted that without medications, based on his past behaviors, "he  


could be very violent," and it could happen quickly.  The psychiatrist did not believe  


there was a viable less restrictive placement for G.L. outside of supervised care where  


he could be forcibly medicated if needed.  


                    The API social worker testified about G.L.'s continual indication that he  


would not take medications upon discharge.  Although G.L.'s sister stated she would  


house him, the social worker believed, based on G.L.'s history, if released he would be  


at risk of harming himself or others. G.L.'s sister testified that she understood he "needs  


some help," and she acknowledged that she could not force him to take medications if  


he were unwilling.  


                    The court issued oral findings at the end of the hearing, stating that G.L.'s  


history indicated he could be "clearly violent and likely to cause harm to others," based  


on his consistent expressions that he would discontinue medications if released.  The  


court described him as a "time bomb if he doesn't take his medication" and noted the  


elevated "risks . . . of catastrophic unfortunate results" if G.L. were unmedicated.  The  


court  stated  that  his  sister's  home  was  not  a  viable  option  based  "on  the  fact  that  


whenever he doesn't take the medication within a week he's assaultive, he's aggressive,  


[and] he has a past history" of violence.  The court's written order confirmed its oral  


findings, noting the psychiatrist's testimony that G.L. began decompensating within a  


week of not taking medications.  The court granted the 90-day commitment, relying on  

                                                               -6-                                                         7412

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


G.L.'spast actions, rapid decompensation rate,and intent todiscontinuemedication upon  




          D.        180-Day Commitment Petition; Appeal  


                    Prior to the 90-day commitment hearing, API filed a 180-day commitment  


petition, relying on the same reasoning it had used for its 90- and 30-day commitment  


petitions.  The court held a hearing in October, and testimony was given by the API  


psychiatrist, the API social worker, and G.L.'s API advanced nurse practitioner.  


                    The psychiatristtestified that, as of July 2017, G.L. no longer was under her  


care.  She stated that her schizophrenia diagnosis had not changed and reiterated that  


G.L. could decompensate within about a week if unmedicated.  She testified about his  


consistent statements that he did not need medications and did not have a mental illness,  


and she discussed her concerns about him leaving API, where he is under constant  


supervision and "can be evaluated immediately" upon early signs of decompensation.  


                    The API advanced nurse practitioner testified that G.L. had been under her  


supervision for the three weeks prior to the hearing.  She agreed with the psychiatrist's  


testimony that G.L. would decompensate rapidly without medications.  She stated that,  


when  asked  whether  he  would  take  medications  upon  leaving  API,  he  had  been  


equivocal,  saying  at  different  times  both  that  he  would  and  would  not  continue  


medications.  She explained that, during the week before the hearing, he had said he  


would not take medications upon discharge because they made him tired and he did not  


believe he had a mental illness.  But she stated that, on the morning of the hearing, he  


had said he would continue medications upon discharge, although he maintained that he  


was not mentally ill.  


                    The advanced nurse practitioner also discussed an incident the prior month  


when  G.L.  had  refused  to  take  oral  medications  and  required  a  forcible  injection.  


According to her testimony, he had refused medications because he did not believe they  

                                                               -7-                                                         7412

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


were necessary or that he had a mental illness. Like the psychiatrist, the advanced nurse  


practitioner testified that no less restrictive treatment alternative would be viable because  


G.L. does not believe he has a mental illness and he needs constant supervision.  


                    The API social worker testified that she had called 212 treatment facilities  


throughout Alaska in search of a viable alternative to API for G.L. Acknowledging that  


her medical knowledge of his case was limited and that medication was outside her  


purview, she stated that the only other facility willing to take him required infeasible on- 


demand outpatient providers for assistance.   Although she still was working on his  


discharge plan, she stated that she "personally [didn't] choose to interact with [him] a  


whole lot" because she was scared of him.  


                    The  superior  court  issued  oral  findings  at  the  end  of  the  180-day  


commitment  hearing,  granting  the  request.                             The  court  found  that  the  one-week  


decompensation  rate  was  "very  concerning"  and  that  there  was  no  less  restrictive  


alternative to commitment at API.  The court stated:  "The issue here is the concern . . .  


that when he stops taking medication, he becomes dangerous. It's not based on a theory  


or  a  possibility,  it's  based  on  the  past  history  of  several  attempted  murders  and  


threatening people in [his village]."   The court noted his "history of sometimes not  


[being] willing to take the medication, other times indicating he would," and that he  


recently required a forced injection after refusing to take oral medications.  The court  


stated that "when we look at his condition now, yes, he is not violent, but that is because  


he is taking . . . medication" and "it would make no sense to simply look in a vacuum at  


the person on the day of the hearing, if they pose no risk on th[at] day because they're  


taking their medication."  The court instead suggested looking to the patient's recent  


history, stating that it could "predict [his] dangerousness" at the time of the hearing based  


on his refusal to take medications, history of violence when he decompensates, and  


recent forced injection.  

                                                                -8-                                                         7412

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

                                     The court issued a written order in November.                                                                                       Acknowledging G.L.'s   

statement on the morning of the hearing that he would continue taking medications if                                                                                                                 

discharged from API, the court dismissed this one-time statement as equivocal, at best,                                                                                                                                         

given his past opposite statements.                                                            The court concluded that he posed a substantial risk                                                                               

of harm to others and that no less restrictive and feasible alternative existed.                                                                                                                                   

                                     G.L.   appeals the 180-day commitment order, arguing he did not pose a                                                                                                                              

substantial risk of harm to others at the time of the commitment hearing.                                                                                                                              

III.	              STANDARD OF REVIEW                                

                                    We review factual findings in involuntary commitment proceedings for                                                                                                                            

clear error, reversing "only if we have a 'definite and firm conviction that a mistake has                                                                                                                                         



been made.' "                             But whether those findings comply with statutory requirements is a legal  




question we review de novo. 



                  POSED A RISK OF HARM TO OTHERS.  


                  A.	               Legal Framework  


                                     To involuntarily commit a patient for 180 days, the superior court must find  


by clear and convincing evidence that the person "is mentally ill and as a result is likely  


                                                                                                                                                   5  We have looked to the statutory  

to cause harm to [self] or others or is gravely disabled."                                                                                                                                                           


definition  of  "likely  to  cause  serious  harm"  to  give  meaning  to  the  involuntary  


                  3                 In   re   Hospitalization   of   Connor   J.,   440   P.3d   159,  163   (Alaska   2019)  

(quoting  In re Hospitalization of Jacob S.                                                                       , 384 P.3d 758, 764 (Alaska 2016)).                                            

                  4                 Id. (quoting Jacob S., 384 P.3d at 764).  


                  5                 AS 47.30.735(c) (providing required findings for 30-day commitment);  


AS   47.30.755(a)   (providing   same   required   findings   for   90-day   commitment);  


AS 47.30.770(b) (incorporating required findings for 90-day commitments into 180-day  



                                                                                                                  -9-	                                                                                                         7412

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


commitment requirement.                               A person is "likely to cause serious harm" if the person                                            

"poses a substantial risk of harm to others as manifested by recent behavior causing,                                                                   

attempting, or threatening harm, and is likely in the near future to cause physical injury,                                                                


physical abuse, or substantial property damage to another person."                                                                   

                          We previously have discussed the relevant time frame the superior court  


can consider in determining whether a patient's recent conduct suffices for involuntary  


commitment. In In re Hospitalization of Tracy C. a patient was involuntarily committed  


for  30  days  based  on  grave  disability8   but  argued  that  the  superior  court  erred  by  


committing her because her condition had stabilized between her admission and her  


commitment hearing.9                          The probate master's findings, adopted by the superior court,  


"recognized that [the patient] had improved somewhat since her admission" but noted  

that her condition remained acute and "without further treatment, she would likely be  


hospitalized again."10  Affirming the involuntary commitment order, we noted testimony  


                                                                                                                                                   11  We thus  

that the patient "had repeatedly stopped taking her medication in the past."                                                                                    


indicated that when granting an involuntary commitment petition the superior court may  


             6            See  In  re  Hospitalization  of  Joan  K.,  273  P.3d  594,  598  (Alaska  2012).  

             7            AS  47.30.915(12)(B).  

             8            The  court  concluded  that,  as  a  result  of  her  mental  illness,  the  patient  would  

"if  not t  reated,  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  deterioration  of  the  person's  previous  ability  

to function independently."   249 P.3d 1085, 1091-92 (Alaska 2011); AS 47.30.915(9)(B)  

(defining  gravely  disabled).  

             9            In re Tracy C., 249 P.3d at 1086.  


             10           Id. at 1094.  


             11           Id. at 1094 n.32.  



                                                                                -10-                                                                          7412

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

consider a patient's treatment history and probability of further hospitalization if the                                                                                     

patient does not take medication.                                     

                            In  In re Hospitalization of Jeffrey E.                                    we similarly affirmed an involuntary                 

commitment order that depended on superior court findings that the patient would not   

                                                                                                                                                 12   Affirming the  

take medication in the future and that he lacked insight into his illness.                                                                                                   

superior court's grave-disability finding, we stated that "even if [the patient] were not  


suffering from distress at the exact time of the hearing, he still could be gravely disabled  


at that time if he would suffer  distress in  the near  future as a result  of  his mental  


illness."13  We thus indicated that the superior court may consider consequences if the  


patient were discharged from hospitalization, including consequences of discontinuing  




                            These cases emphasize that the superior court must find likelihood of harm  


to self or others based on the patient's condition at the time of the commitment hearing:  


"The superior court may not involuntarily commit a patient based only on the patient's  


symptoms at the time of admission to a treatment facility if by the time of the hearing the  


patient is no longer mentally ill . . . or likely to harm [self] or others."14                                                                       But in making  


the finding the superior court "may consider the patient's recent behavior and condition  


as well as the patient's symptoms on the day of the hearing" and the patient's treatment  




              12            281  P.3d  84,  88-89  (Alaska  2012).  

              13           Id.  at  88.   

              14           In  re  Tracy  C.,  249  P.3d  at   1092.  

              15           Id.  at   1093,   1094  n.32.   

                                                                                     -11-                                                                                7412

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


          B.        Analysis  


                    G.L. argues that the superior court erred by finding that he was likely to  


cause harm to others at the time of the 180-day commitment hearing because it "relied  


on  outdated  -  rather  than  recent  -  behavior,  which  is  insufficient  to  justify  an  


involuntary commitment."  He clarifies in his reply brief that he is not disputing the  


court's underlying factual findings, instead contending that "given the stale nature of  


th[e] testimony, additional testimony of recent  conduct was necessary."   The State  


disagrees, arguing that thesuperior court appropriately determined he was likely to cause  


harm to others if released.  


                    In  finding  that G.L.  posed  a risk  of harm to  others  at the time of the  


commitment hearing, the superior court primarily relied on the testimony of the API  


psychiatrist,  advanced  nurse  practitioner,  and  social  worker.                                G.L.  argues  that  the  


aggregated testimony was "legally insufficient to support a commitment order" and that  


the superior court needed more information for four main reasons:  (1) the psychiatrist  


had not seen him for three months prior to the 180-day commitment hearing; (2) the  


social  worker  testified  that  she  did  not  interact  with  him;  (3)  the  advanced  nurse  


practitioner,  who  interacted  with  him  most  recently,  testified  about  his  one-time  


statement that he would continue medication if discharged; and (4) in recent months he  


had refused medication only once and had displayed no signs of real aggression.  


                    But the superior court did not err by relying on the testimony to find that  


G.L. presented a risk of harm at the time of the commitment hearing.  And contrary to  


G.L.'s assertion, the evidence was sufficient for the superior court to make this finding.  


The court found that although he was not violent on the day of the hearing, that was  


"because he is taking . . . medication."  The court concluded that G.L. presented a risk  


of  harm  to  others  based  on  his  past  actions,  indication  that  he  would  discontinue  


medication upon discharge, and rapid decompensation rate.  The record supports each  

                                                               -12-                                                         7412

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

of these subsidiary findings and establishes that the superior court considered recent, as                                                                                                                                                                                                                                                                                                                                                           

opposed to "outdated," evidence to determine G.L. posed a risk of harm to others as                                                                                                                                                                                                                                                                                                                                                                

manifested by recent behavior.                                                                                                                                    

                                                                     First, nearly all the evidence favored finding that G.L. would discontinue                                                                                                                                                                                                                                                    

medication if discharged; the only evidence suggesting otherwise was his expression on                                                                                                                                                                                                                                                                                                                                                             

the morning of the hearing that he would continue medication, but he still did not                                                                                                                                                                                                                                                                                                                                                          

understand the nature of his mental illness or accept his diagnosis.                                                                                                                                                                                                                                                                                   His actions through                                             

the   180-day   commitment   hearing   supported   finding   that   he   would   not   continue  

medication if given the choice; he had refused medication just two weeks before the                                                                                                                                                                                                                                                                                                                                                           

hearing,   requiring   a   forcible   injection,   in   part   because   he   believed   he   was   neither  

mentally ill nor needed medication.                                                                                                                                                        

                                                                      Second, ample evidence suggested that G.L. could become dangerous if                                                                                                                                                                                                                                                                                                            

unmedicated. The court emphasized the non-theoretical nature of this possibility, noting                                                                                                                                                                                                                                                                                                                                       

"it's based on [his] past history of several attempted murders and threatening people in                                                                                                                                                                                                                                                                                                                                                             

                                                                      16  G.L.'smorerecent historyofdangerous behavior toward others included  

 [his village]."                                                                                                                                                                                                                                                                                                                                                                                                   

 assaulting a DOC officer, trying to assault an API staff member, having angry outbursts  


                                   16                                Although G.L.'s reply brief seems to challenge evidence of the alleged                                                                                                                                                                                                                                                                             

2015 shooting as not properly before the superior court, testimony from earlier hearings                                                                                                                                                                                                                                                                                                                           

 supported this finding, and the superior court stated that it had reviewed the entire record                                                                                                                                                                                                                                                                                                                                  

prior to ordering the 180-day commitment.                                                                                                                                                                                     At the 90-day commitment hearing the API                                                                                                                                                                    

psychiatrist testified that she had discussed the shooting with G.L.:                                                                                                                                                                                                                                                                                    "He told me that he                                                                       

 shot  at   people   in   [his   village]   because   he   was   tired   of   people   telling   him   to   take  

medications.     He   was   tired   of   people   talking   about   him.   .   .   .   He   said   he   used   a  

 shotgun . . . ."                                                                At the same hearing G.L.'s sister, who was reluctant to discuss the                                                                                                                                                                                                                                                                                          

 shooting, acknowledged that "he had a gun" and "one of the people that he went after                                                                                                                                                                                                                                                                                                                                                  

had picked on him his whole life."                                                                                                                                                Following that hearing the superior court found that                                                                                                                                                                                                      

 G.L.  "previously acted on . . . delusions in both [his village] and at API . . . . In [his                                                                                                                                                                                                                                                                                                                                               

village], he had shot a shotgun at people."                                                                                                                                                                          See  AS 47.30.770(d) (allowing superior court                                                                                                                                                                   

to rely on findings made at 30-                                                                                                                                  and 90-day commitment hearings).                                                                                                   

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a few months before the 180-day commitment hearing, and requiring forced medication                                                                                                                                                                                                 

injections on two separate occasions, one just two weeks before the hearing.   Taken  


together, the superior court did not clearly err when it determined that when he "stops  


taking medication, he becomes dangerous."                                                                                                                         

                                                 Finally, the record supports finding that G.L. could quickly become violent                                                                                                                                                                        

if  his  medications  were  discontinued.                                                                                                                  The  API  psychiatrist  and  advanced  nurse  


practitioner both testified to the short time frame - about a week - in which G.L. could  


decompensate if unmedicated.                                                                                         The court did not clearly err by finding that it could                                                                                                                            

"predict [his] dangerousness based on the time of the hearing" because G.L. had at                                                                                                                                                                                                                                   

various  times  refused  to  take  his  medications,  had  recently  required  a  forced  


intramuscular injection, and had a history of violence upon decompensation.                                                                                                                                               

                                                 In sum, the superior court properly applied the involuntary commitment                                                                                                                                                       

statute when it granted the 180-day commitment petition based on G.L.'s condition at the                                                                                                                                                                                                                          

time of the hearing, and the superior court properly considered his recent symptoms and                                                                                                                                                                                                                        

behavior   in   making   that   determination.   We   therefore   affirm   the   superior  court's  

commitment order.                                                       

V.                       CONCLUSION  

                                                 The superior court's decision is AFFIRMED.  


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