Dane County v. M.A.A., 2024AP1589, 12/27/24, District IV (one-judge decision; ineligible for publication); case activity
The Court of Appeals affirmed the circuit court’s order authorizing involuntarily administering medication to M.A.A. in light of evidence that M.A.A. denies he has a mental illness.
M.A.A. was committed under Chapter 51 due to a history of schizophrenia spectrum disorder. The commitment at issue arose after M.A.A.’s mother and roommate reported that he stopped taking medication, was setting fires, was paranoid, twisted his mother’s arm, and threatened to beat his roommate. (¶¶ 4-5). He appealed the circuit court’s finding that he was incompetent to refuse medication.
Two experts testified at the commitment hearing. Both experts said M.A.A. was not compliant with medication after his prior involuntary commitment order expired. Both examiners also reported that M.A.A. denied he had a mental illness, refused to identify his mental health diagnosis, and insisted that he was misdiagnosed. The experts stated that M.A.A.’s schizophrenia impaired his judgment and insight into his mental illness and his need for medication. (¶ 7).
Dr. Taylor testified that she recommended M.A.A. be involuntarily administered Invega and that she discussed the risks, benefits, and alternatives to Invega with him. The doctor said M.A.A. was substantially incapable of applying this information to his mental illness because his judgment and insight were impaired by schizophrenia to the extent that he did not believe he was mentally ill, was doing well without medication, and saw no need to resume medication. (¶ 8).
M.A.A. testified that he was currently prescribed medication, which “sort of” improved his mental health previously. M.A.A. said he preferred Invega over Abilify because he was “used to it.” When asked if he would continue medication voluntarily, he said: “Yes, but I don’t believe I am –“, at which point his counsel interrupted his answer. (¶ 9).
The circuit court concluded the County met its burden that M.A.A. was incompetent to refuse medication because he does not “completely understand the advantages, disadvantages, and alternatives to his . . . condition in order to make an informed choice as to whether to accept or refuse psychotropic medication.” (¶ 10). The circuit court’s written order stated that because of his mental illness, M.A.A. is “substantially incapable of applying an understanding of the advantages, disadvantages and alternatives to his . . . condition in order to make an informed choice as to whether to accept or refuse psychotropic medications.” (¶ 10).
M.A.A. argued on appeal there was insufficient evidence to support the circuit court’s finding that he was incompetent to refuse medication under Wis. Stat. § 51.61(1)(g)4.b (authorizing involuntary medication if “individual is substantially incapable of applying an understanding of the advantages, disadvantages and alternatives to his or her mental illness, developmental disability, alcoholism or drug dependence in order to make an informed choice as to whether to accept or refuse medication or treatment”).
The Court found that the experts sufficiently explained the advantages and disadvantages of Invega to M.A.A., noting that Dr. Taylor testified that M.A.A. previously took and responded well to Invega and that she discussed the risks, benefits, and alternatives to Invega with M.A.A. (¶ 16). The Court rejected M.A.A.’s argument that Dr. Taylor did not provide him with an explanation of the nature of his mental illness because § 51.61(1)(g)4. only requires an explanation of the medication at issue, not the nature of the person’s mental illness. (¶ 17).
The Court also found the County adequately established a connection between M.A.A.’s mental illness and his inability to apply an understanding of the advantages and disadvantages of medication. The Court cited Dr. Taylor’s testimony that M.A.A.’s symptoms — distorted and delusional thinking, paranoia about food, aggressive behavior, and unintelligible speech – “impaired M.A.A.’s judgment such that he had no insight into his mental illness and was adamant that he was not mentally ill and that he was doing well without medication.” (¶ 20). Although the Court recognized that Dr. Taylor did not explicitly state that M.A.A.’s distorted thinking and judgment were why he lacked insight into his mental illness, the Court considered it reasonable for the circuit court to infer that M.A.A.’s symptoms caused his inability to apply an understanding of the advantages, disadvantages, and alternatives to medication. (¶ 20).
Next, M.A.A. argued that the circuit court made a clearly erroneous finding when it stated that M.A.A. did not “completely understand” the advantages and disadvantages of medication in light of Dr. Taylor’s testimony that he understood the advantages and disadvantages of medication, but could not apply that understanding due to his mental illness because he was denied that he was mentally ill. The Court, however, found the evidence sufficient to support the circuit court’s conclusion that M.A.A. was substantially incapable of applying an understanding of the medication given the experts’ testimony that he denies he has a mental illness. (¶ 26).
Finally, the Court rejected M.A.A.’s argument that his ability to express a preference for Invega over Abilify shows that he could apply an understanding of the advantages and disadvantages of medication. The Court noted Dr. Taylor’s testimony that M.A.A. was “adamant that he was not mentally ill, that he had been misdiagnosed as having a mental illness, and that he was doing well without medication . . . ‘despite the very, very, clear advantages that [he] has had on medication.” The Court cited Melanie L.’s holding that, “’if a person cannot recognize he or she has a mental illness, logically the person cannot establish a connection between his or her expressed understanding of the benefits and risks of medication and the person’s own illness.’” (¶ 26).
