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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  

           corrections@akcourts.us.  



                      THE SUPREME COURT OF THE STATE OF ALASKA                                      



In  the  Matter  of  the  Necessity  for  the                        )  

Hospitalization  of                                                  )    Supreme  Court  No.  S-16928  

                                                                     )  

G.L.                                                                                                                               

                                                                     )    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.  



I.         INTRODUCTION  



                                                                                                                                    

                     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                                                                                                                                                                                                       



mid-April.   



                                                                            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                                                                                                                                                                                                                                                                                                                                                                                 



 outbursts.   



                                                                           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                                                         

                                                                                                                                                                                                                                                                                                                                                                                                                             (continued...)  



                                                                                                                                                                                                                                            -3-                                                                                                                                                                                                                             7412
  


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

 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                                                                                                                                                                                                                                                                                                              



month.    



                                  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  



                  

discharge.  



                                                                                      

          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                                                                                                                                         



                                     3  

                                                                                                                                                                                                                             

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



                                                                               4  

                                                                                   

                                                               

question we review de novo. 



IV.	              THESUPERIORCOURTDIDNOTERRBYDETERMININGTHATG.L.  

                                                                                                                                                                                                                                               

                  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  

                                                                                                                                                                                                                      

commitments).  



                                                                                                                  -9-	                                                                                                         7412
  


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

                                                   6  

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,                                                                



                                                                                                                                 7  

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  

                                                                                                                                                       



medication.  

                          



                            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  

                                                                                                                                                                

history.15  

                      



              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.   



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          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  



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----------------------- 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).                                                                                                   



                                                                                                                                                                                                                      -13-                                                                                                                                                                                                             7412
  


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

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.  

                                                                                                                                                                       



                                                                                                                                                       -14-                                                                                                                                                7412
  

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