Matter of Jarvis

Citations: 433 N.W.2d 120; 1988 Minn. App. LEXIS 1216; 1988 WL 130866Docket: C8-88-1785

Court: Court of Appeals of Minnesota; December 13, 1988; Minnesota; State Appellate Court

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The Court of Appeals of Minnesota reversed and remanded a trial court order that authorized the forcible administration of neuroleptic medications to Homer Jarvis, who has been committed as a mentally ill and dangerous person since 1977. Jarvis, diagnosed with a paranoid disorder or schizophrenia, has consistently refused treatment and denied his mental illness. His violent behavior has escalated, leading to attacks on patients and staff at the Minnesota Security Hospital. Despite prior attempts at alternative therapies and multiple approvals from a treatment review panel for medication use, Jarvis's condition worsened.

In June 1988, the Medical Director petitioned for authorization to administer medications. Jarvis was assigned an attorney, who faced challenges in preparing for the hearing due to limited access to Jarvis's medical records. Jarvis declined to attend the hearing but was represented by counsel, who requested the appointment of additional examiners for a second opinion on Jarvis's mental health and medication. This request was opposed by the Medical Director’s counsel, citing a lack of statutory authority and timeliness. The court heard testimony from psychiatrist Charles Van Valkenburg, who indicated that neuroleptic medications would benefit Jarvis more than they would pose risks. Ultimately, the appellate court found the trial court's proceedings inadequate and ordered a new hearing to address the issues raised.

The trial court denied Jarvis' motion for the appointment of a second examiner but suggested it may have granted it if requested before the hearing. The court approved the administration of neuroleptic medications, which Jarvis did not contest on appeal, instead arguing for the need for additional expert appointment. The central issue is whether the trial court erred in denying this request. The Minnesota Supreme Court established in Jarvis v. Levine that facilities must adhere to the 'Price procedure' when administering neuroleptic medications without consent, which emphasizes a patient's constitutional right to privacy and requires judicial oversight for intrusive treatments. This includes appointing a guardian ad litem and conducting an adversary proceeding to assess the necessity and reasonableness of the treatment, considering factors like treatment benefits, risks, and patient competence. Although the trial court's findings addressed these factors, neither the original Price procedures nor their extension in Jarvis mandated the appointment of additional experts. The administrative rules do not address this issue either. Jarvis also references a legislative amendment allowing patients, including those committed as mentally ill and dangerous, to petition for hearings regarding neuroleptic medication administration, a change reflecting the court’s earlier ruling.

The amendment allows for a hearing on a patient's petition regarding medication to be conducted under sections 253B.09 and 253B.12, which pertain to initial commitment and review hearings. The law mandates the trial court to appoint an examiner, either a licensed physician or psychologist, to evaluate the patient’s diagnosis and treatment during proceedings under section 253B.17. A patient may request a second examiner of their choice. This right extends to initial commitment proceedings and certain reviews, ensuring the patient can challenge involuntary medication administration. The respondent contends that the provision for a second examiner is exclusive to petitions initiated by the patient, but this interpretation is rejected. 

It is noted that all petitions for involuntary medication are typically initiated by treating professionals, yet the legislature allows patients to raise medication issues in court. The respondent's argument could lead to unnecessary multiple hearings, undermining legislative intent to provide independent examination throughout the commitment process. The supreme court emphasized that the Jarvis hearing should not merely validate hospital treatment decisions. 

The trial court indicated it would have appointed an examiner if the patient’s request had been made timely; however, it misjudged the timeliness of the request. The newly appointed counsel had limited time to prepare and access to medical records was delayed. Thus, the request for a second examiner was deemed timely under the circumstances. While the appellant sought an additional opinion on treatment, concerns were raised regarding a request for a new diagnosis, as the hearing’s focus was intended to be on treatment rather than diagnosis. The patient’s mental illness has been variably diagnosed, highlighting the uncertainty in their condition as recognized by the supreme court.

The trial court's role was to assess the appropriateness of nonconsensual intrusive medical treatment for Jarvis, not to establish a medical diagnosis, which is the responsibility of Jarvis' treatment team. The court rightly declined to appoint an additional examiner regarding the diagnosis. Although the respondent included parts of Jarvis' medical records in their brief without objection from the appellant, prior rulings emphasize the importance of safeguarding private medical data from public disclosure. To protect patient privacy, the counsel withdrew the medical records from the public file and recommended that, if needed for appellate review, they should be submitted in a separate confidential appendix rather than being included in the brief. The decision concludes that Jarvis is entitled to a second examiner concerning involuntary medication, and since this request was timely, the court reverses the previous ruling and remands the case for a new hearing on the medical director's petition for authorization to administer neuroleptic medications.