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In re D. L. B.

Supreme Court of Montana

January 3, 2017

IN THE MATTER OF: D. L. B., Respondent and Appellant.

          Submitted on Briefs: November 2, 2016.

         APPEAL FROM: District Court of the Tenth Judicial District, In and For the County of Fergus, Cause No. DI 2015-11 Honorable Jon A. Oldenburg, Presiding Judge.

          For Appellant: Chad Wright, Chief Appellate Defender, Kristen L. Peterson, Assistant Appellate Defender, Helena, Montana

          For Appellee: Timothy C. Fox, Montana Attorney General, Katie F. Schulz, Assistant Attorney General, Helena, Montana

          Thomas P. Meissner, Fergus County Attorney, Craig R. Buehler, Special Deputy County Attorney, Lewistown, Montana


         ¶1 D.L.B. appeals the order of the Tenth Judicial District Court, Fergus County, recommitting him for a period of up to six months to the Montana Mental Health Nursing Care Center (Nursing Care Center) in Lewistown. We affirm, and state the issue as follows:

         Did the District Court err by extending D.L.B.'s commitment to the Nursing Care Center?


         ¶2 D.L.B. is a 75-year-old male who, unfortunately, has suffered from mental illness his entire adult life. He was originally diagnosed with paranoid schizophrenia after his first psychotic episode, at age 22. Since this initial diagnosis, D.L.B. has been involuntarily committed to mental hospitals throughout his life. D.L.B.'s May 2015 Mental Health Assessment for Recommitment states that he has been involuntarily committed to mental health hospitals at least six times and that other "[r]ecords indicate [that] he [has] likely had other psychiatric hospitalizations through the years, but [complete] information is not available."[1] D.L.B.'s last four hospital commitments, in 2004, 2011, 2012, and 2014, were to the Montana State Hospital (MSH).

         ¶3 D.L.B.'s psychosis centers around a fear of the Nazis and of being persecuted by them. He also suffers from delusions regarding an imaginary wife and children who reside in Canada. Critically, he has a pervasive history of medication noncompliance arising from his belief that he does not suffer from a mental illness.

         ¶4 D.L.B.'s 53-year history of mental illness evidences a relatively predictable and cyclical pattern, typically beginning with a psychotic episode. During these episodes, he acts out and is a physical danger to himself, as well as to others. The episodes typically result in an involuntary commitment of D.L.B. to a mental health hospital, where he is medicated and begins to stabilize. After improving, D.L.B. is transferred from the hospital to a mental health nursing care facility, where supervision helps him to stay on his medication and maintain stability. After he is released from the mental health nursing care facility to a community based rehabilitation center or treatment program, he typically stops taking his medicine, leading to another psychotic episode and a repeat of the cycle.

         ¶5 At the July 8, 2015, recommitment hearing, the District Court verbally summarized D.L.B.'s condition as follows:

[D.L.B.] does suffer from a mental disorder that being paranoid schizophrenia which in his case causes him to have a lack of insight in to his own mental disorders and how those affect him and leads to a persistent desire and a pattern of medication refusal and removing himself from the medication which then causes his mental disorder to spiral out of control and causes [D.L.B.] to decompensate and have to start over again with his treatment. This presents a danger to [D.L.B.] as each and every time he has to start over it takes more and more to get him back to normal and during those psychotic episodes he's a danger to himself and could be a danger to others just basically due to his lack of insight and ability to control himself.

         ¶6 In 2014, D.L.B. was living at a rehabilitative center in Dillon when he again refused to take his medicine. He decompensated to the point that he "believed staff at the facility were contracting with the Nazi's [sic] to torture him and inflict pain on him with infrared devices." He became verbally aggressive and attempted to physically strike the staff, leading to his commitment to MSH on September 23, 2014. On March 24, 2015, after he had stabilized, D.L.B. was transferred from MSH to the Nursing Care Center. Based on his behaviors, however, D.L.B. was considered an elopement risk. At the Nursing Care Center, D.L.B. received regular medical and psychiatric care. Despite this care, D.L.B. continued to have visual hallucinations and paranoid delusions, be verbally and physically aggressive toward the staff, refuse to take his medication, and isolate himself. On June 2, 2015, the State filed the subject petition to extend D.L.B.'s commitment to the Nursing Care Center for further evaluation and treatment.

         ¶7 In support of the petition, the State submitted a report by Susan Stevens (Stevens), a Mental Health Professional.[2] Stevens' report explained that D.L.B. had a long history of medication noncompliance and, consequently, a recurring inability to successfully live independently in ...

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