Dane County v. A.M.M., 2024AP1670, 2/13/25, District IV (1-judge decision, ineligible for publication); case activity
“Amanda” challenges the sufficiency of the evidence pertaining to her medication order. The COA calls this a “close case,” but affirms.
Amanda stipulated to a ch. 51 commitment during a voluntary admission to a psychiatric hospital. Prior to her admission, family members reported that Amanda had been refusing food and beverage because she believed it was being poisoned, and that the situation had escalated from self-neglect to the point of neglect and abuse of her children. Following her hospital admission, there was an unprovoked altercation
in which Amanda attempted to choke another resident. (¶2).
Both examiners’ reports stated that they had explained the advantages and disadvantages of and alternatives to the recommended course of medication, and opined that Amanda was capable of expressing an understanding of the advantages and disadvantages of and alternatives to accepting medications, § 51.61(1)(g)4.a., and Amanda was not substantially incapable of applying that understanding to her condition in order to make an informed choice as to whether to accept or refuse medication, § 51.61(1)(g)4.b. (¶5). However, one doctor amended her report after discovering that Amanda had twice attempted to avoid taking prescribed medications and hid her actions from staff. As a result, her initial opinion that Amanda was substantially capable of applying her understanding to her condition changed. (¶6).
At the final hearing, Amanda stipulated to the commitment but opposed a medication order. Amanda and the advanced practice nurse practitioner who had been treating her at the hospital testified. Much of the testimony, and the arguments, focused on whether Amanda would voluntarily comply with the recommended medication. (¶¶7-14). The circuit court found that, although Amanda “might understand the medication is helping her, she has demonstrated she cannot apply that understanding to continue taking her medications.” (¶15).
On appeal, Amanda argues that the County did not satisfy its burden of proof under the Wis. Stat. § 51.61(1)(g)4.b. standard. Under this subsection, the County must show that “because of mental illness,” the person “is substantially incapable of applying an understanding of the advantages, disadvantages and alternatives [of the prescribed medication] to [the person’s] mental illness … in order to make an informed choice as to whether to accept or refuse medication.” This standard is “somewhat relaxed” and “less rigorous” than the first. Outagamie County v. Melanie L., 2013 WI 67, ¶¶54, 70, 349 Wis. 2d 148, 833 N.W.2d 607.
Relying on Melanie L., COA agrees with Amanda that the hearing’s “significant focus” on future compliance is problematic. (¶23). But that only makes this a “close case” according to COA, as the County did also present testimony about Amanda’s ability to process information and apply it to her own condition before making the choice to accept or refuse medication. (¶24). The court then rejects Amanda’s apparent argument that her testimony should overcome that of the County’s witness. (¶¶7-14).
Although the briefs are not available, it seems that Amanda tried to use Outagamie County v. L.X.D.-O., 2023 WI App 17, ¶¶33-34, 407 Wis. 2d 441, 991 N.W.2d 518, to her advantage here. COA acknowledges that it can rely on the reports given that this is an initial commitment proceeding. However, it “find[s] nothing in those reports that undermines [its] conclusion that the County satisfied its burden of proof at the hearing.” (¶27). COA therefore concludes that the County proved by clear and convincing evidence that Amanda was substantially incapable of applying an understanding of the advantages and disadvantages of and alternatives to medication.
