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In re C.A.H.

July 13, 2010

IN THE INTEREST OF C.A.H.
NORTH DAKOTA STATE HOSPITAL, PETITIONER AND APPELLEE
v.
C.A.H., RESPONDENT AND APPELLANT



Appeal from the District Court of Stutsman County, Southeast Judicial District, the Honorable John E. Greenwood, Judge.

The opinion of the court was delivered by: Kapsner, Justice.

AFFIRMED.

[¶1] C.H. appeals a district court order for hospitalization and treatment and an order to treat with medication. We hold the district court's findings that C.H. is a person requiring treatment and involuntary hospitalization is the least restrictive form of appropriate treatment are not clearly erroneous, and the district court did not err by ordering involuntary treatment with medication. We affirm the district court orders.

I.

[¶2] C.H. is a 38-year-old male. On February 8, 2010, C.H.'s sister filed a petition under oath with the district court for C.H.'s involuntary commitment. The petition claimed C.H. was mentally ill and, as a result, there was a reasonable expectation of a serious risk of harm if he did not receive treatment. C.H.'s sister also included a letter as part of the sworn petition, which stated in part:

My biggest fear is that [C.H.] is going to cause harm to my family. Comments such as "your children should not have to live in this terrible world and deal with all the bad stuff" and "I wish Dad was not around", scare me to the core. My brother [D.H.] would not make a statement due to his fear of [C.H.] from an incident in which [D.H.] was physically hurt.

....

I am scared for my husband, children, parents, and myself. I am scared of [C.H.] stopping by our home again, because I am scared to ask him to leave. We are fearful of [C.H.].... I am very scared of what he is physically capable of doing. I do not want any of my family members hurt, or dead.

The district court held a preliminary hearing on February 18, 2010. The district court found there was probable cause to believe C.H. is a person requiring treatment and ordered C.H. undergo involuntary treatment at the North Dakota State Hospital for up to fourteen days.

[¶3] The district court held a treatment and medication hearing on April 28, 2010. Dr. William Pryatel, a psychiatrist at the state hospital, testified he had personally treated C.H. since his most recent commitment in February, as well as during several previous commitments. Pryatel stated C.H. suffers from "Schizoaffective Disorder Bipolar Type" and an associated personality disorder. Pryatel testified C.H. had been treated at the state hospital on approximately six previous occasions, with the same pattern of behavior often repeating. Pryatel stated the general pattern involves C.H. "getting off the medication, becoming manic, then getting to the attention of the authorities somehow or the other and then being sent here to the State Hospital." Since being committed in February 2010, Pryatel testified C.H.'s behavior included "delusional speech... pressured speech, elevated mood, agitation, [and] irritability."

[¶4] Pryatel stated C.H. poses a risk of harm to others because "on the outside his family is all afraid of him.... They've made statements that are on the chart here about his behavior in the community... and they feel threatened by him." Pryatel testified C.H. also made a threatening statement to a state hospital staff member: "[C.H.] said quote that Navy bitch better watch out, when I get out I'll be looking for him and showing him what I can do." Pryatel stated C.H. has also pointed his finger towards staff members' noses and invaded their body space in a manner "that we would consider physically intimidating because he's a large man." Despite behavior he considers threatening, Pryatel acknowledged C.H. has not been physically violent since his most recent commitment.

[¶5] Pryatel testified there was a substantial risk of deterioration in C.H.'s physical health if the temporary order for hospitalization and treatment was not extended. Pryatel stated C.H. was not suffering from any physical ailments when he was committed to the state hospital in February 2010. However, Pryatel testified:

The way [C.H.] is right now I don't feel that he can live in a homeless shelter because his behavior is just too intense, too manicky that they would not be able to deal with him.... I don't feel he can be employable the way he is right now. So I don't really feel he can provide himself food, clothing and shelter in his current condition.

Pryatel also stated there is a substantial risk of deterioration in C.H.'s mental health because "one follows the other that the more the physical health is impaired the more the mental health will follow behind...."

[¶6] Pryatel testified C.H. requires treatment with medication. Pryatel stated the state hospital has offered medication to C.H., but he has refused. He testified medication would help C.H. become "less manic," no longer have "rambling disorganized speech," make "rational decisions," and generally improve his self-control. Pryatel stated medication has helped C.H. in the past: "There's no indication that [C.H.] would not respond to [medication] just fine at this time. He has gotten some... medication [during previous involuntary hospitalizations] at the State Hospital and for a period afterwards he's been more calm." Pryatel testified the proposed medications have "motor side effects which have to do with the voluntary musculature" and "metabolic side effects," such as weight gain and increased risk for diabetes, stroke, and heart attack. Pryatel stated no treatment other than hospitalization and medication was appropriate because C.H. is "just too manicky to be managed in the community," and he has "a history of poor medication compliance."

[¶7] Dr. Harjinder Virdee, a private practice psychiatrist, testified she performed an independent evaluation of C.H., which included a one-hour meeting with C.H. and a review of his state hospital records. Virdee testified C.H. suffers from "Schizoaffective Disorder Bipolar Type," as well as "Antisocial Personality traits." Virdee stated C.H.'s mental illness was "[s]ufficiently severe... to necessitate hospitalization to prevent harm to self or others or other psychotic features." Virdee testified C.H. would have difficulty taking care of his physical needs because "the level of communicative difficulties that [C.H. is] having would interfere with a meaningful employment or taking care of himself." Virdee also testified C.H. presents a danger to himself and others because he has a history of driving offenses, and "one of the things that happens in manic state, the person starts to feel over confident and drive very fast. And when they drive very fast they endanger themselves and others." Virdee noted documentation from C.H.'s family members indicates they feel threatened by him as well.

[¶8] Without treatment, Virdee testified C.H.'s mental health would likely deteriorate because C.H. "was not able to judge for himself that his thought processes were off...." Speaking more generally, Virdee stated: "One of the reasons why we think about deterioration [of mental health] is manic phase can lead into manic psychosis and mania is when you would want to catch it and treat it because it could deteriorate into a psychotic state." Virdee testified C.H. is "right on the edge" of going from mania to psychosis. Virdee also stated C.H. requires treatment with medication, which would improve C.H.'s thought process and mood. Virdee testified inpatient treatment is the best alternative for C.H. at this point: "I think, you know, when he gets better he could be in out-patient but I think at this point he needs something to help him slow down and to be able to control his impulses...."

[¶9] C.H. testified on his own behalf and acknowledged a history of mental illness:

I did have a psychosis in the past when I used methamphetamine when I was about 26 years old, 27. After I got divorced I went into a depression.... But there was no mania. Excited about getting different business opportunities, yes. Excitement, normal, not jump off the building mania. Now when I had the psychosis, like I said, when you asked if I was mentally ill I had a psychosis that was called paranoia.

C.H. stated methamphetamine use caused previous chemical imbalances, but he has not used for several years. When asked about the circumstances leading to his most recent commitment, C.H. stated: "Three sheriff's came to me at the homeless shelter and when I was [there] at the homeless shelter they said I wasn't making my keep there because I couldn't get North Dakota help for unemployment." C.H. ...


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