In the Matter of the Civil Commitment of: Susan E. Lein.

This opinion will be unpublished and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
A18-0993

In the Matter of the Civil Commitment of: Susan E. Lein.

Filed December 24, 2018
Affirmed
Stauber, Judge*

Hennepin County District Court
File No. 27-MH-PR-18-434

Mark Gray, Minneapolis, Minnesota (for appellant Susan E. Lein)

Michael O. Freeman, Hennepin County Attorney, John L. Kirwin, Assistant County
Attorney, Minneapolis, Minnesota (for respondent Hennepin County)

Considered and decided by Rodenberg , Presiding Judge; Hooten , Judge; and
Stauber, Judge.
U N P U B L I S H E D O P I N I O N
STAUBER, Judge
On appeal from her commitment as mentally ill, appellant argues that the record
does not support the findings that are the basis for the determination that appellant is a
danger to herself or others. We affirm.

* Retired judge of the Minnesota Court of Appeals, serving by appointment pursuant to
Minn. Const. art. VI, § 10.

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FACTS
The manager of the apartment building where appellant Susan E. Lein lived called
police because she believed that Lein might be suicidal. Two Edina police officers
responded, and, shortly after they arrived, Lein exited her apartment and “was immediately
defensive and upset” on meeting with the officers. Lein’s conversation did not stay on
track, and her emotions ranged from being upset and yelling to being sympathetic with the
officers. Lein tried to walk away and continued walking away after being told she was not
free to leave. When the officers grabbed her arms to prevent her from leaving, Lein began
“screaming, swearing, pulling away and flailing her arms around and toward [the
officers].” Lein would not calm down, so the officers handcuffed her for their safety and
hers.
Lein was transported to the University of Minnesota Medical Center (UMMC).
Emergency room staff noted that Lein had a previous diagnosis of chronic schizophrenia,
that she reported a history of multiple hospitalizations, and that she stated that she felt less
stable than usual and was having difficulty sleeping and had a poor appetite.
Lein was admitted to the hospital’s psychiatric unit, where she was evaluated by
psychiatrist Lora Wichser. Lein was reluctant to disclose information, and her behavior
was irritable, paranoid, and confrontational. Lein was diagnosed with schizophrenia vs.
schizoaffective disorder vs. bipolar disorder with psychotic features, 1 prescribed

1 The connector “vs.” is used when the diagnosing professional cannot definitively
determine a diagnosis among multiple similar disorders. Am. Psychiatric Ass’n Diagnostic
& Statistical Manual of Mental Disorders 124 (5th ed. 2013).

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medications, and placed her on “suicide precautions.” Wichser noted that Lein had a
history of similar diagnoses.
Two days after her hospital admission, Lein was yelling on the phone and then was
rude to staff when instructed to return to her room. Back in he r room, Lein became
increasingly hostile and agitated; she was yelling, swearing, throwing pillows, and banging
her feet on the wall. Multiple doses of medication were administered in an effort to control
her agitation. Jeffrey Olson, a psychiatric ass ociate who evaluated her a few hours later,
described her as paranoid, delusional, tense, and angry.
Lein exhibited delusional thoughts regarding the effects of psychiatric medications,
believing that Abilify and lithium had damaged her adrenal glands, thyroid, and spine. She
also believed that toxins were leaking from “various orifices of her body” due to her use of
Abilify for seven years, although she said she ha d most recently used Abilify eight years
earlier. Lein did suffer from hypothyroidism, but the record contains no medical evidence
supporting her claim that Abilify damaged her thyroid. Lein’s other complaints about the
effects of those drugs are unsubstantiated by any medical evidence.
UMMC filed petitions to judicially commit Lein as me ntally ill and to administer
medications to treat her mental illness. The district court appointed psychologist Catherine
Carlson, Psy.D., to examine Lein. At the commitment hearing, Carlson testified that Lein
suffered from a mental illness, which she diagnosed as either schizoaffective disorder or
bipolar disorder with psychosis. Carlson described Lein as suffering from a psychotic
illness with strong evidence of manic symptoms. Carlson testified that Lein’s belief that
she was suffering from Abilify poisoning was delusional.

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Carlson concluded that Lein’s mental illness presented a risk of harm to her in
multiple ways. First, Lein’s delusions about having health problems related to her previous
use of Abilify impacted her ability to understand her medical condition. Lein’s refusal to
take medication to treat her hypothyroidism could cause long -term harm. Carlson also
testified that Lein was not competent to make decisions on psychiatric medications because
she had “somatic delusions and concerns about medications” and was not cooperative. In
addition, Lein’s statements that caused the apartment manager and responding police
officers to believe that she was suicidal and her aggressive behavior with others when in a
manic state made her a possible ri sk of harm to herself. Carlson opined that commitment
was the least restrictive alternative to meet Lein’s needs and protect her from harm.
A referee issued recommended orders (1) committing Lein as mentally ill to UMMC
and to the Minnesota Commissioner of Human Services and (2) authorizing her treating
physicians to administer certain psychiatric medications to her. The district court
confirmed the orders. Lein appeals the confirmed orders.
D E C I S I O N
Our review of an involuntary civil commitment is limited to examining whether the
district court complied with statutory requirements and whether the commitment is
“justified by findings based upon evidence at the hearing.” In re Knops, 536 N.W.2d 616,
620 (Minn. 1995). We will not reverse a district court’s factual findings unless they are
clearly erroneous, giving deference to the district court’s credibility determinations. Id.
But we review de novo whether the evidence is sufficient to support the d istrict court’s

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determination that a person meets the standards for commitment. In re Thulin, 660 N.W.2d
140, 144 (Minn. Appl. 2003).
To civilly commit a person as “mentally ill,” the district court must find by clear
and convincing evidence that the pers on meets the statutory criteria for commitment.
Minn. Stat. § 253B.09, subd. 1 (a) (2018).
A “person who is mentally ill” means any 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 self or others as demonstrated by:
(1) a failure to obtain necessary food, clothing, shelter,
or medical care as a result of the impairment;
(2) an inability for reasons other than indigence to
obtain necessary food, clothing, shelter, or medical c are as a
result of the impairment and it is more probable than not that
the person will suffer substantial harm, significant psychiatric
deterioration or debilitation, or serious illness, unless
appropriate treatment and services are provided; [or]
(3) a recent attempt or threat to physically harm self or
others[.]

Minn. Stat. § 253B.02, subd. 13(a) (2018).
Lein challenges the sufficiency of the evidence to show that she posed a substantial
likelihood of harm to herself or others. Lein argues that her h ealth concerns were not
corroborated and the district court did not commit her for any failure to provide medical
care. But medical evidence showed that Lein’s thyroid -stimulating hormone level was
significantly elevated and that her refusal to take thyro id medication could result in long -
term harm. Lein’s refusal to take the thyroid medication resulted from her delusional

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beliefs about the effects of Abilify on her body. Lein also refused to take the full dose of
psychiatric medications likely to stabil ize her mental condition. This refusal was a result
of her delusional beliefs about the effects of Abilify and other medications.
Lein objects to the district court’s finding that “[t]he reporting party contacted police
to report that [Lein] was possibly suicidal.” Lein incorrectly asserts that no evidence was
introduced on the reporting party’s identity. The reporting party was identified in the police
report and the party’s name was contained in the hospital report and provided at the
commitment hearing. Lein also objects to the finding as based on hearsay evidence. Minn.
Stat. § 253.B.08, subd. 7 (2018), permits the admission of relevant and reliable hearsay as
evidence in civil commitment proceedings. In re Civil Commitment of Williams , 735
N.W.2d 727, 730-33 (Minn. App. 2007), review denied (Minn. Sept. 26, 2007) ; see also
Minn. Spec. R. Commit. & Treat. Act 1(a), 15. Lein also argues that the “informant” who
stated that Lein said she should not be around anymore and should flush herself down the
toilet was not identified. The police report identifies the reporting party as the person who
made this statement.
Lein argues that the evidence is insufficient to show that she was suicidal. It was
unnecessary for the evidence to show that Lein was suicidal given her aggressive behavior
toward the police and hospital staff. See Minn. Stat. § 253B.02, subd. 13(a) (requiring
substantial likelihood of harm to self or others). Regarding Lein’s interaction with police,
the district court found that Lein’ s “agitated and aggressive behavior poses a danger to
others, and also poses a risk to herself by possibly inciting violence in others.” The district
court noted that Lein “struggled with the police, despite the fact that the responding officers

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appeared to be assisting her in transporting her to the hospital.” The court cited Carlson’s
testimony that Lein experienced “periods of extreme agitation,” including a “dangerous
interaction with the police.” Lein also behaved aggressively while hospitalized, describing
herself as “decompensating” and “being more hostile, swearing at people I don’t even
know.” Lein’s conduct leading up to and during her hospitalization created a threat of
physical harm to herself and others.
Clear and convincing evidence supports the findings underlying the district court’s
determination of a substantial likelihood of harm to self or others and its decision to commit
Lein as mentally ill. See In re Gonzalez , 456 N.W.2d 724, 729 (Minn. App. 1990)
(affirming commitment when, among other things, appellant posed “a likelihood of harm
to himself by his conduct which may outrage others and result in attack on him”); In re
Martin, 458 N.W.2d 700, 705 (Minn. App. 1990) (finding substantial likelihood of harm
to self or others when appell ant became threatening and was easily provoked, and his
behavior would likely present a threat in the community).
Affirmed.