Price County v. C.N.S., 2024AP853, District III, 1/22/25 (one-judge decision; ineligible for publication); case activity
Appellant CNS wins a battle but loses the war as the COA affirms the circuit court’s order extending her commitment under Ch. 51, but reverses order authorizing involuntary medication. The Court clarified that a circuit court meets D.J.W.’s requirement to make a specific factual finding with reference to the subparagraph of Wis. Stat. § 51.20(1)(a)2. on which the recommitment is based if the circuit court’s oral ruling referred to the wording of the statute, even if the court did not cite the specific subparagraph.
“Cynthia” was committed under Chapter 51 in August 2023 after she attempted to take her life. During her commitment at a treatment facility, she was taken to a medical center when staff were concerned about symptoms she exhibited. Cynthia tested positive for THC and was diagnosed with hepatic encephalopathy due to her THC use in combination with her stage-four liver disease. She also made “suicidal comments” at the medical center. In September 2023, Cynthia left the medical center without authorization and was found drinking alcohol. She was then transferred to a more restrictive, inpatient treatment facility. (¶¶ 3-6).
In December 2023, Price County petitioned to extend Cynthia’s commitment. At the final hearing, Dr. John Coates, a psychologist, testified that Cynthia suffers from major depressive disorder and alcohol use disorder, which create a “substantial probability of serious injury, debilitation, or disease” as demonstrated by her six prior attempts to take her life. (¶ 8). Dr. Coates said she would be a proper subject for treatment if treatment were withdrawn because she would likely cause physical harm to herself due to an increased risk of taking her life. (¶ 8). Regarding medication, Dr. Coates testified that Cynthia was substantially incapable of applying an understanding of the advantages, disadvantages, and alternatives to medication in order to make an informed choice whether to accept or refuse medications due to her limited insight and impaired judgment. However, Dr. Coates did not elaborate on her insight and judgment and testified on cross-examination that “perhaps the lightbulb has finally gone on, and she recognizes she needs help, and is appreciative of the help.” (¶ 9).
Cynthia testified that, prior to her commitment, she had never received treatment for her depression. Since starting treatment, she said her mood has stabilized, she has increased clarity, and her memory is improved. (¶ 10). Cynthia testified she would continue treatment and voluntarily stay at the facility if the commitment were removed. On cross examination, Cynthia acknowledged she used cannabidiol (CBD) in the preceding six months, but did not know that her damaged liver affected her ability to process CBD. She admitted she left the medical center against her doctors’ advice, consumed alcohol, and consumed THC 13 days before the hearing. (¶ 11).
The circuit court found that Cynthia is mentally ill, a proper subject for treatment, and is “dangerous” under Wis. Stat. § 51.20(1)(a)2.a. (evidences a substantial probability of physical harm to herself). The court also concluded she would be a proper subject for commitment if treatment were withdrawn under Wis. Stat. § 51.20(1)(am). The circuit court authorized involuntarily administering medication to Cynthia. (¶¶ 12-13).
On appeal, Cynthia challenged the circuit court’s order authorizing involuntarily administering medication and its finding that she was “dangerous” for purposes of extending her commitment.
Regarding involuntary medication, the County conceded there was insufficient evidence to show that Cynthia was not competent to refuse medication. The Court noted that Dr. Coates testified that she was capable of expressing an understanding of the advantages and disadvantages of medication. Although the psychologist questioned her ability to apply that understanding, his testimony that perhaps “the lightbulb” has finally gone on convinced the Court that the evidence was insufficient to find that Cynthia is not competent to refuse medication. (¶ 16).
Regarding dangerousness, Cynthia argued that the County only proved at the final hearing that she was dangerous under Wis. Stat. § 51.20(1)(am), but did not link her current dangerousness to one of the five statutory standards in § 51.20(1)(a)2.a.-e., as required by SCOW’s decision in K.E.K. (§ 51.20(1)(am) requires proof of current dangerousness). (¶ 17).
The Court found that the County presented clear and convincing evidence that Cynthia was “dangerous” because she presented a substantial probability of causing physical harm to herself (§ 51.20(1)(1)2.a.) in light of the following testimony by Dr. Coates: 1) Cynthia’s major depressive disorder and alcohol use disorder affect her ability to recognize reality and meet the ordinary demands of life; 2) she was unable to abstain from alcohol and her use of alcohol could create a substantial probability of serious physical injury, debilitation, or disease and prevented her from properly caring for her diabetes; 3) a substantial likelihood that her risk of taking her life, alcohol abuse, and “life threatening medical problems” would increase if treatment were withdrawn; and 4) she attempted to take her life six times. (¶¶ 21-22). The Court concluded that Dr. Coates’ testimony was sufficient to prove that Cynthia was dangerous to herself under § 51.20(1)(a)2.a. and would be a proper subject for commitment if treatment were withdrawn under § 51.20(1)(am). (¶ 25).
Although the circuit court did not expressly cite in its oral ruling the dangerousness subparagraph under § 51.20(1)(a)2. on which it relied, and SCOW held in D.J.W. that a circuit court must make a specific factual finding with reference to the subparagraph on which the recommitment is based, the Court noted that the circuit court’s oral ruling referred to the wording of § 51.20(1)(a)2.a. and identified § 51.20(1)(a)2.a. as the applicable standard of dangerousness in its written order, which were sufficient to meet the requirement of D.J.W. (¶ 28).
