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In re D.L.B.

Supreme Court of Montana

May 8, 2017

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

          Submitted on Briefs: March 1, 2017

         APPEAL FROM: District Court of the Tenth Judicial District, In and For the County of Fergus, Cause No. DI 15-11 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

          OPINION

          DIRK M. SANDEFUR, JUSTICE

         ¶1 D.L.B. appeals the order of the Tenth Judicial District Court, Fergus County, recommitting him to the Montana Mental Health Nursing Care Center (Nursing Care Center) for a period of up to one year. We conclude the order's factual findings are deficient and remand for entry of an amended order in compliance with the express requirements of §§ 53-21-127 and -128(1)(d), MCA.

         Did the District Court's findings of fact meet the statutory requirements regarding alternative placement options?

         BACKGROUND

         ¶2 D.L.B. has suffered from paranoid schizophrenia since his diagnosis at age 22 following a psychotic break. Now 76 years old, D.L.B.'s long history of mental illness includes numerous involuntarily psychiatric hospitalizations in Washington and Montana. When his disorder was not well managed by medication, D.L.B. became unable to meet and maintain his most basic needs of food, clothing, shelter, health, and safety.

         ¶3 On March 24, 2015, D.L.B. was transferred to the Nursing Care Center from the Montana State Hospital (MSH). Within 90 days of the transfer, certified mental health professional Susan Stevens, M.S., L.M.F.T., petitioned to extend D.L.B.'s commitment. Following an evidentiary hearing, the District Court recommitted D.L.B. to the Nursing Care Center for up to six months. D.L.B. appealed and this Court affirmed. In re D.L.B. (D.L.B. I), 2017 MT 1, ¶ 20, 386 Mont. 180, 389 P.3d 227.

         ¶4 On December 18, 2015, Stevens petitioned for a second extended commitment on the ground that D.L.B. continued to suffer from a mental disorder requiring evaluation and treatment. The District Court appointed counsel and designated D.L.B.'s sister as his court-appointed "friend." At a contested hearing on January 22, 2016, Stacie Klemo, registered nurse supervisor at the Nursing Care Center, testified at length regarding D.L.B.'s mental disorder, daily assistance needs, and general treatment plan.

         ¶5 Susan Stevens evaluated D.L.B.'s condition at the time of the hearing as declining, depressed, and delusional. Stevens testified that D.L.B.'s history of medication noncompliance reflected his near total lack of insight regarding his mental illness. Stevens described a recurring pattern where D.L.B.'s psychiatric condition would stabilize during an involuntary hospitalization but then destabilize upon discharge due to medication noncompliance. Without daily medication, D.L.B.'s disorder would spiral out of control, causing rapid decompensation and renewed need for involuntary inpatient treatment. Stevens analyzed the alternative placements available and testified that, while D.L.B. experienced a serious and chronic mental illness, he did not require the acute level of care provided at MSH. However, according to Stevens, D.L.B.'s history demonstrated an inability to successfully manage in a community placement, even with extensive support services. Stevens further ruled out nursing home care due to D.L.B.'s active psychosis and because nursing homes cannot administer involuntary medication when needed. Stevens thus concluded that the Nursing Care Center was the least restrictive placement for effective treatment of D.L.B. At the hearing, D.L.B. contrarily stated he would rather live in a nursing home than remain at the Nursing Care Center.

         ¶6 At the close of the hearing, the District Court entered oral findings of fact from the bench that D.L.B. required recommitment, the Nursing Care Center was the least restrictive placement for effective treatment, and involuntary administration of necessary medication was in his best interest. On February 9, 2016, the Court entered written findings of fact, conclusions of law, and an order recommitting D.L.B. for involuntary mental health treatment at the Nursing Care Center.

         STANDARD OF REVIEW

         ¶7 We review involuntary civil commitment orders to determine whether the district court's findings of fact are clearly erroneous and its conclusions of law are correct. In re S.M., 2014 MT 309, ¶ 13, 377 Mont. 133, 339 P.3d 23. Upon review of involuntary commitment proceedings, we review the evidence in the light most favorable to the prevailing party. In re G.M., 2007 MT 100, ¶ 12, 337 Mont. 116, 157 P.3d 687 (citation omitted). Whether a district court's findings of fact satisfy statutory requirements is a question of law reviewed for correctness. S.M., ¶ 13; In re Mental Health of E.P.B., 2007 MT 224, ¶ 5, 339 Mont. 107, 168 P.3d 662.

         DISCUSSION

         Did the District Court's findings of fact meet the statutory requirements regarding alternative placement options?

         ¶8 Title 53, chapter 21, MCA, sets forth specific procedural and substantive requirements for involuntary civil commitment proceedings. No later than two weeks before an involuntary commitment expires, the responsible professional may petition the court to extend commitment upon a specified showing of need for the extension. Section 53-21-128(1)(a), MCA. Except for the right to a jury trial, the extension procedure "must be the same in all respects as the procedure" required for an initial mental health commitment. Section 53-21-128(1)(c), MCA.

         ¶9 If the court finds on hearing that the respondent "continues to suffer from a mental disorder and to require commitment" under any of the substantive criteria of § 53-21-126(1), MCA, then "the court shall order commitment" in accordance with § 53-21-127, MCA. Section 53-21-128(1)(d), MCA. At a separate dispositional hearing, the court must determine the least restrictive placement for effective treatment from the alternatives specified in § 53-21-127(3), MCA. Sections 53-21-127(5) and -128(1)(d), MCA. The selected placement alternative must be based on a "comprehensive individualized plan of treatment." Section 53-21-128(1)(d), MCA.

         ¶10 Whether "stated on the record" or by written "opinion or memorandum of decision, " district courts must generally make findings of fact and conclusions of law stating the factual and legal bases for decisions in civil matters. M. R. Civ. P. 52(a)(1). In extending a prior involuntary mental health commitment, district courts must make specific findings of fact:

(1) stating in detail "the facts upon which the court found the respondent to be suffering from a mental disorder and requiring commitment" under the commitment criteria of §§ 53-21-126, -127(8)(a), and -128(1)(d), MCA;
(2) describing "what alternatives for treatment of the [respondent] are available, " §§ 53-21-127(8)(c) and -128(1)(d), MCA;
(3) describing "what [treatment] alternatives were investigated, " §§ 53-21-127(8)(b) and -128(1)(d), MCA;
(4) describing "why the investigated alternatives were not found suitable, " ยงยง 53-21-127(8)(d) and ...

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