Sandra Lynn Baumgartner appeals the mandatory outpatient treatment (MOT) plan imposed by the Shelby County Criminal Court following her acquittal of first-degree murder due to insanity. Baumgartner argues that the trial court incorrectly mandated outpatient treatment because the evidence does not indicate that her mental condition is likely to deteriorate to a point where she would pose a serious threat to others. Furthermore, she claims the MOT plan is inconsistent with medical evidence, punitive, oppressive, and unmanageable. The court finds that the evidence does not support the requirements for Baumgartner to live in a supervised residential facility or to have supervision for her medication administration. Consequently, the court modifies the MOT plan, removing these requirements, and remands the case for the trial court to reinstate the condition for Baumgartner to reside with her parents. The original trial established that Baumgartner had Schizoaffective Disorder, Bipolar Type, and was not capable of understanding the wrongfulness of her actions at the time of the offense. Following a state petition, she underwent evaluation at the Memphis Mental Health Institute, where a team recommended her discharge into the community under a proposed MOT plan that includes regular outpatient services and medication management from a nurse practitioner and psychiatrist.
The defendant's treatment plan involves intensive management by FFCC's Continuing Treatment Team (CTT), including weekly meetings with case manager Hugh Callens, who will oversee appointments, transportation, and medication compliance. Callens will report behavioral observations to Dr. Baker for ongoing monitoring of the defendant's mental health and medication needs. Noncompliance with the treatment plan will be reported to the FFCC treatment team and supervising administrator Laverne Hoke, who may inform the court of any violations.
The defendant is required to attend weekly alcohol and drug treatment meetings coordinated by Hoke, subject to random drug screenings, with the trial court notified of any positive results within seven days. She must also attend Alcoholics Anonymous (AA) meetings weekly and receive individual therapy bi-monthly from Dr. Robert Serino.
The defendant will reside with her parents, ensuring they are the only occupants of their home. The FFCC will oversee the treatment plan, including monitoring compliance and notifying the court of any issues. The plan has been endorsed by the defendant, her parents, Hoke, and Dr. Serino.
During a December 6, 2002 hearing, Dr. McNeal, a licensed psychologist, testified regarding the defendant's previous mental health treatment and the circumstances surrounding her offense, which involved stabbing a victim 120 times. He noted that her symptoms were well-controlled, and she did not meet the criteria for continued hospitalization. He attributed the violent incident to a medication error and highlighted her lack of aggressive behavior prior to and following the incident. Dr. McNeal affirmed the necessity of a "fairly intensive" community treatment plan, emphasizing the importance of a supportive living environment with her parents, who would regularly monitor her mental stability. He clarified that the living arrangements were not solely for monitoring her medication adherence.
The defendant is deemed capable of managing her medication independently, needing only regular visits to a mental health facility for monitoring. Discussions about medication changes prior to the offense revealed her understanding of the implications involved. If noncompliance occurs, outpatient providers can facilitate her return to a hospital and notify the court. Dr. Eric Smith, a psychiatrist involved in her evaluation, noted her mental illness includes psychotic and mood symptoms, treated with medications such as Geodon and Seroquel. He emphasized the importance of these medications for preventing psychotic symptoms and stated that the substitution of Seroquel with Serzone had led to a recurrence of psychosis due to lack of proper management.
Dr. Smith also highlighted the switch from Depacoat to Trileptal due to side effects, with Trileptal serving as a mood stabilizer. Missing medications would not produce immediate effects, but could lead to manic behavior and increased impulsivity over time, raising risks of violent behavior. Stability allows the defendant to work, and frequent healthcare provider visits are recommended for her benefit and community safety. Shirley McGowen, a counselor from FFCC, explained the center's role in providing comprehensive outpatient mental health services, supported by TennCare funding.
The defendant underwent outpatient treatment at FFCC for approximately one year post-offense before being transferred to MMHI, during which she adhered to her medication regimen and showed no symptoms indicating non-compliance. Ms. McGowen, who worked with the defendant, described her as a good patient striving to maintain stability despite the stress from the offense. The proposed MOT plan would involve more intensive interaction with a case manager, visiting weekly at home, compared to the previous arrangement of bi-monthly visits. However, Advocare ceased enrolling patients in FFCC’s continuous treatment team, which is crucial for the defendant to follow her MOT plan, unless an exception is made.
Other outpatient options include monthly meetings with Dr. Patty Jordan, a pharmacologist, and potential assessments from Dr. Clayton Baker, a psychiatrist. Weekly group meetings at FFCC could also help monitor the defendant's progress in alcohol treatment. A monthly home visit from a case manager was recommended, given the defendant's current stability. FFCC does not provide daily medication dispensing; patients needing such services must be in supervised settings. Ms. McGowen noted that non-compliant patients are contacted to understand their issues, emphasizing the closer monitoring needed for MOT patients.
Laverne Hoke confirmed that TennCare would not fund the proposed MOT plan but would support a less intensive outpatient treatment involving regular consultations with Dr. Baker, psychological sessions, and counseling, reiterating that FFCC does not provide daily medication administration.
Supervised residential homes were mentioned as a service option, but it was believed that the defendant functioned at a higher level than the residents there. Testimony from the defendant's mother, Carol Baumgartner, indicated that the defendant's mental condition was stable during her treatment at FFCC, noting she could attend meetings independently and was responsible in taking her medication. Carol clarified that the offense occurred due to the defendant taking the wrong medication, not from noncompliance with her prescribed regimen. Robert Baumgartner, the defendant’s father, corroborated that she was compliant with her medication and functioned normally at home, with only minor behavioral changes noted prior to the offense.
The defendant, a registered nurse, confirmed her adherence to the medication regimen and expressed a desire to work, although she indicated challenges if required to commute to FFCC. She expressed willingness to comply with court orders, including temporary residence in a facility if mandated.
The trial court approved a mandatory outpatient treatment (MOT) plan with several stipulations: residential housing with 24-hour supervision, supervised medication administration five days a week, attendance at AA meetings three times weekly with a sponsor, biannual doctor visits, and monthly reporting to the court. The defendant's treatment professional was also required to submit reports every six months regarding her ongoing treatment needs.
Following the MOT plan's implementation, the defendant was detained at MMHI beyond the legally allowed 90 days due to the lack of available suitable residential treatment. This situation prompted a separate habeas corpus appeal, resulting in the court ordering her release to her parents' home under the agreed MOT plan while the appeal was pending. The defendant argued that the trial court’s findings did not meet the statutory criteria for mandatory outpatient treatment, contesting the assertion that her mental condition was likely to deteriorate to a level posing substantial harm.
The state asserts that mandatory outpatient treatment is essential for the defendant, and the court concurs, finding evidence supporting this necessity. After an acquittal due to insanity, the court may mandate outpatient treatment if it determines that the defendant's mental condition is likely to worsen rapidly, posing a substantial risk of serious harm as outlined in Tenn. Code Ann. 33-7-303(b)(3) and 33-6-501. A substantial likelihood of harm can arise from threats of self-harm or violence to others, or from incapacity to manage risks without treatment.
The court reviews the necessity for outpatient treatment de novo, presuming correctness unless the evidence suggests otherwise. The defendant argues against the need for treatment, citing her ability to manage her condition as a registered nurse, strong family support, and a history of compliance with medication. She maintains that her previous psychotic episode was due to a third party's error, not her noncompliance, and references a prior ruling indicating she did not pose a continuous danger.
However, the court finds the defendant misinterprets the statute, as her ability to maintain medication is irrelevant to the inquiry about the potential for deterioration without treatment. Dr. Eric Smith testified that discontinuation of her medication could lead to psychosis and aggressive behavior, indicating a risk of harming others. Dr. Travis McNeal supported the need for 'fairly intensive' mandatory outpatient treatment. Thus, the trial court's conclusion that the defendant's mental state would likely deteriorate rapidly without treatment is upheld, and the evidence does not contradict this finding.
The defendant contests modifications to her mandatory outpatient treatment (MOT) plan, specifically the requirements for twenty-four-hour residential treatment and daily supervised medication administration. She argues that Dr. McNeal indicated she does not require supervision for her medication or living situation, citing her successful treatment adherence while living with her parents on bond. The defendant claims the lack of available facilities for twenty-four-hour supervision renders this aspect of her MOT plan unfeasible and requests reinstatement of the original plan from September 9, 2002.
In contrast, the state argues that the defendant misinterprets testimony from her habeas corpus hearing and asserts that evidence from a later hearing indicates she does need supervision. The court finds that the trial court's requirement for twenty-four-hour supervision violates statutory provisions for outpatient treatment, which allows for outpatient participation only if the defendant's mental condition poses a risk of rapid deterioration and serious harm.
The court interprets the term "outpatient" to mean that the patient should not reside in a treatment facility, based on legislative intent and the plain meaning of the term, as well as statutory definitions contrasting outpatient services with inpatient care. The court concludes that mandating the defendant to live in a facility providing twenty-four-hour supervision is inconsistent with the outpatient treatment model. The court acknowledges previous cases where such requirements were imposed but notes that their appropriateness was not part of the current appeal.
The court referenced cases involving defendants in Shelby County to address the imposition of treatment requirements on the defendant, who is not deemed to need twenty-four-hour residential supervision or supervised medication administration. The MMHI treatment team recommended that the defendant live with her parents during mandatory outpatient treatment, highlighting their supportive environment and ability to monitor her mental stability. Expert testimony indicated that the defendant is higher functioning than individuals in supervised facilities, and there was no evidence supporting the need for such supervision. Although the defendant's parents’ monitoring abilities were questioned, they had not observed any change in her condition before the offense, and she had been compliant with her medication regimen prior to the incident. Dr. Smith indicated that any notable changes in her mental state would take days to manifest without medication. The court found that the requirement for supervised medication administration five days a week was also unsupported, as the defendant, a registered nurse, was capable of managing her medication independently. The trial court's imposition of mandatory outpatient treatment was affirmed, modifying it to eliminate the requirements for residential supervision and medication monitoring. The defendant's continued compliance and the potential lack of funding for the treatment plan were noted. The case was remanded for modification of the treatment plan, specifically reinstating the condition of living with her parents.
