In the Matter of the Civil Commitment of: David Austin Russell.

This opinion will be unpublished and
may not be cited except as provided by
Minn. Stat. § 480A.08, subd. 3 (2018).

STATE OF MINNESOTA
IN COURT OF APPEALS
A18-0833

In the Matter of the Civil Commitment of: David Austin Russell.

Filed December 17, 2018
Affirmed
Florey, Judge

Winona County District Court
File No. 85-PR-18-815

Joyce A. Svoboda, Svoboda Law O ffice, Lake City, Minnesota (for a p p e l l a n t D a v i d
Russell)

Karin L. Sonneman, Winona County Attorney, Susan E. Cooper, Ass istant County
Attorney, Winona, Minnesota (for respondent)

Considered and decided by Florey, Presiding Judge; Ross, Judge ; and Reyes, Judge.
U N P U B L I S H E D O P I N I O N
FLOREY, Judge
Appellant David Austin Russell challenges the district court’s order continuing his
commitment as mentally ill and th e authorization of neuroleptic medications,
1 arguing
there was insufficient evidence in the record to support the court’s decision. We affirm.

1 “ N e u r o l e p t i c s ” a r e a c l a s s o f m e d i c a t i o n s t h a t e f f e c t u a t e a “ sedation of the nervous
system.” Jarvis v. Levine, 418 N.W.2d 139, 140 n.1 (Minn. 1988).

2
FACTS
Appellant, a 38-year-old male, has a history of prior commitmen ts dating back to
June 2014. His first psychiatric episode, however, was at age 18. According to his medical
records, appellant attempted to p oison his father and stepmothe r with bleach, and he was
hospitalized after attempting suicide.
Appellant struggles with reocc urring delusions and hallucinatio ns, many of which
involve allegations of being sexually assaulted and tortured during his hospitalizations. In
a psychiatric assessment from Ma rch 2018, his doctor observed t hat “[appellant] has so
much emotional stake on [these false convictions] that unfortunately, he gets agitated when
he tries to demand to obtain records from both his hospitalizat ions as well as the court
system.” His doctor stated that appellant’s behavior “invariably has resulted in additional
charges against him and more neg ative experiences where he is b ound to feel abused.”
Appellant has been diagnosed with paranoid schizophrenia, anxie ty, depression, post-
traumatic stress disorder (PTSD), and a reported history of traumatic brain injury.
Beginning in early January 2018, appellant was hospitalized at the Community
Behavioral Health Hospital (CBHH) in Rochester. On March 1, 2018, he was provisionally
discharged. Upon his release, he reported being unable to sleep, and believed that people
were drugging him through the vents in his apartment. The next day, appellant went to a
gas station and asked a stranger for a gun so he could kill himself. Appellant’s sister called
law enforcement after receiving a text from him saying that he wanted to die.
Within less than 24 hours of being provisionally discharged, appellant was returned
to another hospital by police. He was placed on a 72-hour hold and transferred to Mayo

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Clinic Hospital’s psychiatric unit. While at Mayo, appellant d isplayed threatening,
aggressive, and paranoid behavior toward staff and patients, an d voiced his desire to
commit suicide. He required involuntary administrations of medication in order to reduce
his psychotic episodes.
On March 22, 2018, appellant was transferred from the psychiatr ic unit and re-
admitted to Rochester’s CBHH. He was provisionally discharged on April 17, 2018, with
his civil commitment and Jarvis order2 set to expire on May 17, 2018. On April 25, 2018,
Winona County filed a petition se eking to continue the commitme nt of appellant as a
mentally ill person. A report pr epared by appellant’s doctor a t CBHH, Dr. Angela Leon
Galat, as well as a pre-petition screening report prepared by appellant’s caseworker, Kristin
Holien, were filed in conjunction with the county’s petition.
In early May 2018, a review hearing on the petition to continue the commitment of
appellant was held. The state r ecommended a continued provisio nal discharge, whereby
appellant would remain in the community in his own apartment. The state called Ms.
Holien to testify and submitted a ppellant’s medical records and a report written by the
court-appointed medical examiner, Dr. Meaghan Johansen.
Although appellant refused to coop erate with Dr. Johansen for h is updated
psychiatric evaluation in preparation for the hearing, she was able to provide the court with
a formal recommendation. Basing her expert opinion on her past examination of appellant

2 I n Jarvis, the Minnesota Supreme Court held that the involuntary adminis tration of
neuroleptic medication must be preauthorized by a court order. 418 N.W.2d at 148-50.
Minn. Stat. § 253B.092, subd. 8 (2018), now provides the procedure and authority for the
involuntary administration of neuroleptic medication.

4
about a year prior, as well as the report filed by Dr. Galat, Dr. Johansen recommended that
appellant be committed.
Ms. Holien, who had been appellant’s case manager since October 2016, testified
that she believed continued commitment was “essential.” She te stified to appellant’s
proclivity to discontinue his medications when he is not subjec t to a Jarvis order, and
described him as becoming increas ingly anxious, agitated, aggre ssive, threatening,
noncompliant, and delusional whe n he stops taking them. Ms. Ho lien stated that she
believed neuroleptic medication was necessary and that a provis ional discharge in the
community was the least restrictive option meeting appellant’s ongoing mental-health
needs.
Appellant preferred to wait outside the courtroom for most of the hearing but agreed
to come in at the end to testify. During his testimony, appell ant stated his intention to
“wean off” his neuroleptic medication once he “stabilized a lit tle bit.” He also displayed
symptoms of his reoccurring delusions and hallucinations, alleg ing, for example, that he
had been a victim of sexual assault and torture in the hospitals to which he had been civilly
committed in the past.
At the close of the hearing, the district court stated its inte ntion to continue
commitment, finding support in the recommendations of Dr. Johan sen, Dr. Galat,
Ms. Holien, and the testimony of appellant himself. Two days later, the district court filed
its order committing appellant to the custody of the commission er of human services for
an additional period not to exceed 12 months, and extending appellant’s Jarvis order during
the term of commitment. This appeal follows.

5
D E C I S I O N
I. There was sufficient evidence in the record to support the stat utory
requirements of Minn. Stat. § 253B.12 (2018) for continued commitment. 
Appellant challenges the district court’s determination that he is a “person who is
mentally ill” within the meani ng of Minn. Stat. § 253B.02, subd . 13 (2018). When
reviewing a civil commitment, we are “limited to an examination of the [district] court’s
compliance with the statute, and the commitment must be justified by findings based upon
evidence at the hearing.” In re Knops, 536 N.W.2d 616, 620 (Minn. 1995). An appellate
court reviews the record in the light most favorable to the district court’s decision and will
not reverse a district court’s findings “unless clearly erroneo us.” Id.; see also In re
McGaughey, 536 N.W.2d 621, 623 (Minn. 1995). We review de novo the dist rict court’s
legal conclusions. In re Thulin, 660 N.W.2d 140, 144 (Minn. App. 2003).
“There must be clear and convincing evidence that a person is mentally ill in order
to commit that person.” In re Civil Commitment of Janckila, 657 N.W.2d 899, 902 (Minn.
App. 2003). Under Minn. Stat. § 253B.02, subd. 13(a), a “perso n who is mentally ill” is
defined as:
[A]ny person who has an organic disorder of the brain
or a substantial psychiatric disorder of thought, mood,
perception, orientation, or memory which grossly impairs
judgment, behavior, capacity to recognize reality, or to reason
or understand, which is manifested by instances of grossly
disturbed behavior or faulty perceptions and poses a substantial
likelihood of physical harm to se lf or others as demonstrated
by:
. . . .
(3) a recent attempt or threat to physically harm self or
others . . . .

6
“[T]he district court may continue an involuntary commitment under a less stringent
standard than an initial commitment.” Thulin, 660 N.W.2d at 144. Under Minn. Stat.
§ 253B.12, subd. 4, the district court must find by clear and convincing evidence that:
(1) the person continues to be mentally
ill . . . (2) involuntary commitm ent is necessary for the
protection of the patient or others; and (3) there is no
alternative to involuntary commitment.

I n d e t e r m i n i n g w h e t h e r a p e r s o n c o n t i n u e s t o b e
mentally ill . . . the court need not find that there has been a
recent attempt or threat to physically harm self or
others . . . . Instead, the court must find that the patient is likely
to attempt to physically harm self or others . . . unless
involuntary commitment is continued.

When continuing an involuntary commitment, a district court’s “findings of fact and
conclusions of law shall specifically state the conduct of the proposed patient which is the
basis for the final determinati on, that the statutory criteria of commitment continue to be
met, and that less restrictive alternatives have been considered and rejected by the court.”
Minn. Stat. § 253B.12, subd. 7. The district court’s reasons f or “rejecting each [less
restrictive treatment] alternative shall be stated.” Id.
Appellant argues that he is not mentally ill within the statuto ry meaning. He
contends that “all of the [d]octors that he has seen and been evaluated by in Winona County
since 2014” as well as “all of Winona County” have a conflict o f interest against him.
Further, he alleges that he has been the victim of sexual assault and torture during his prior
civil commitments.
We conclude there was sufficient evidence in the record to supp ort the district
court’s finding that the statutory requirements of Minn. Stat. § 253B.12, subd. 4, were met.

7
After considering the recommendations of Dr. Johansen, Dr. Galat, and Ms. Holien, as well
as the testimony of appellant himself, the district court found that appellant continued to
be mentally ill and that “[i]nvol untary commitment [was] necessary for the protection of
[appellant] as he [was] likely to attempt to physically harm himself, or fail to meet his basic
needs if his commitment [was] not continued.” The district court found that the structure
and supervision of commitment was necessary “to stabilize [appellant’s] mental health so
he [could] remain safely in the community” and that there was “ no less restrictive
alternative to commitment.”
In accordance with Minn. Stat. § 253B.12, subd. 7, the district court’s findings of
fact and conclusions of law specifically stated appellant’s con duct that was the basis for
the court’s final determination:
[Appellant] continues to have a substantial psychiatric disorder
of mood, specifically, Schizoph renia, Paranoid Type, which
grossly impairs [appellant’s] judgment, behavior, capacity to
recognize reality, and to reas on and understa nd. [Appellant]
continues to experience symptoms of his mental illness,
including delusional thoughts . [Appellant] has expressed
suicidal thoughts as recently as early March 2018.

Given the recommendations to the district court of Dr. Johanse n, Dr. Galat, and
Ms. Holien, as well as appellant’s medical records and testimony displaying symptoms of
his mental illness, we conclude there was sufficient evidence t o support the statutory
requirements of Minn. Stat. § 253B.12, and, therefore, the district court properly continued
appellant’s commitment. See Thulin, 660 N.W.2d at 144 (affirming continued commitment
where the evidence in the recor d was sufficient to support the statutory requirements of
Minn. Stat. § 253B.12, subd. 4).

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II. There was clear and convincing evi dence in the record to suppor t the district
court’s order authorizing the continued involuntary administrat ion of
neuroleptic medications.
Appellant also challenges the district court’s order authorizin g the continued
involuntary administration of neu roleptic medications. “Court approval is required to
administer neuroleptic medication to a person who refuses it.” Thulin, 660 N.W.2d at 145
(citing Minn. Stat. § 253B.092, subd. 8(a); Jarvis, 418 N.W.2d at 144). Under Minnesota
law, a “patient is presumed to have capacity to make decisions regarding administration of
neuroleptic medication.” Minn. S tat. § 253B.092, subd. 5(a) (2 018). To determine
whether a patient has the capacity to make such a decision, the court considers:
(1) whether the person dem onstrates an awareness of
the nature of the person’s situ ation, including the reasons for
hospitalization, and the possibl e consequences of refusing
treatment with neuroleptic medications;
(2) whether the person demonstrates an understanding
of treatment with neuroleptic medications and the risks,
benefits, and alternatives; and
(3) whether the person communicates verbally or
nonverbally a clear choice regarding treatment with
neuroleptic medications that is a reasoned one not based on
delusion, even though it may not be in the person’s best
interests.

Minn. Stat. § 253B.092, subd. 5(b) (2018). The court’s determi nation must be supported
by “clear and convincing evidence.” Thulin, 660 N.W.2d at 145.
We conclude there was clear and co nvincing evidence in the reco rd to support the
district court’s order. Ms. Holien testified to appellant’s be havior when he discontinues
his medication and stated that it was her professional opinion that neuroleptic medication
was necessary. The district court also considered the expert opinion of Dr. Johansen, who

9
stated that appellant “decompensates” when he is not receiving appropriate medication,
and “[a]t those times, he lacks i nsight to seek treatment.” Dr . Johansen recommended
“[o]ngoing compliance with presc ribed neuroleptic medication,” a s a p p e l l a n t h a d b e e n
observed “to have improvement on appropriate medications in the past.” Lastly, the district
court heard from appellant himself, who stated that he planned t o “ w e a n o f f ” t h e
neuroleptic medication once he “stabilized a little bit.”
The district court indicated tha t one of the reasons supporting its decision to
continue commitment was appellant’s “lack of compliance with medication.” It stated that
“[appellant] himself says he’ll only use the medication until h e wants to wean off on his
own,” and “then we go into this cycle of downward spiral.” The district court found
appellant to have “limited insi ght into his mental illness” and “a history of stopping
neuroleptic medications when he is not under a commitment status, with a deterioration in
his mental health.” Accordingly, the district court authorized the Jarvis order to remain in
full force and effect during appellant’s continued commitment.
Based on the testimony that was presented at the review hearing a s w e l l a s t h e
medical records and reports that were submitted to the district court, we conclude there was
clear and convincing evidence to support the district court’s o rder authorizing the
continued involuntary administration of neuroleptic medications.
Affirmed.