In the Matter of the Civil Commitment of: Brian James Turner.

STATE OF MINNESOTA
IN COURT OF APPEALS
A20-0523

In the Matter of the Civil Commitment of:
Brian James Turner.

Filed September 14, 2020
Affirmed
Smith, Tracy M., Judge

Cass County District Court
File No. 11-PR-19-2239

Jean Gustafson, Brainerd, Minnesota (for appellant Brian James Turner)

Keith Ellison, Attorney Genera l, Brandon Boese, Assistant Attorney General, St. Paul,
Minnesota (for respondent Dr. Chad Erickson, M.D., on be half of Minnesota Department
of Human Services’ Forensic Services)

Considered and decided by Florey, Presiding Judge; Reilly, Judge; and Smith,
Tracy M., Judge.
S Y L L A B U S
In the absence of a request for a subs titute decision-maker, Minn. Stat. § 253B.092
(2018) does not require that th e district court consider wh ether to appoint a substitute
decision-maker before it orders the involunt ary administration of neuroleptic medication
to a patient subject to civil commitment.
O P I N I O N
SMITH, TRACY M., Judge
Appellant Brian James Turner challenges th e district court’s grant of an order for
the involuntary administration of neurolep tic medications pursuant to Minn. Stat.
§ 253B.092, arguing that the district cour t erred by issuing the order without first

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considering whether to appoint a substitute decision-maker for Turner. Because the statute
does not require the district court to consid er the appointment of a substitute decision-
maker in the absence of a request, we affirm.
FACTS
Turner was civilly committed to the cust ody of the Commissioner of the Department
of Human Services (DHS) on January 23, 2020. Turner is 26 years old and has a history of
schizophrenia, which led to two prior civ il commitments. When untreated, his mental
illness manifests in psychosis and paranoia. After Turner was released from a previous
commitment, he went to live with his pa rents and, while there, stopped taking his
prescribed medication. He then began experiencing hallucinations and paranoia, which led
to erratic and at times aggressive behavior. As a result, the district court ordered the current
civil commitment and Turner was placed at the Community Behavioral Health Hospital in
Bemidji (CBHH-Bemidji).
About a week after he was committed, Turner’s treating ps ychiatrist at CBHH-
Bemidji, Dr. Chad Erickson, filed a petition on behalf of respondent DHS asking the
district court to authorize involuntary administration of neuroleptic medication to Turner.
Neuroleptic medications, as explained by Dr. Erickson, are medications used to “improve
mental functioning through a decrease in the psychotic symptoms of mental illness,
including psychotic thinking, distorted perceptions, emotional disturbance, and
pathological behaviors.” Turner had refused to take any neuroleptic medications because
he did not believe that they would help him, because he did not believe that he was mentally
ill.

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The district court held an evidentiar y hearing on the petition and heard testimony
from Dr. Erickson, a court-appointed examiner, and Turner. Dr. Erickson explained that he
had treated Turner in the past and that Turn er previously responded well to neuroleptic
medications, specifically two medications. Dr. Er ickson testified that , to his knowledge,
Turner had not suffered adverse side effects from either medication. He explained that
neuroleptic medications were the best treatment option for Turner in his current state and
that alternative treatments such as therapy would not suffice due to Turner’s degree of
psychosis. He also opined that Turner was not presently capable of understanding the risks
and benefits of neurol eptic medications because his schi zophrenia greatly impaired his
insight and decision-making abilities on the matter.
The court-appointed exam iner agreed with Dr. Er ickson’s diagnosis of
schizophrenia and similarly conc luded that Turner lacked in sight into his mental illness
and need for medication. The court-appointed examiner testified that, although some of the
concerns that Turner expressed about side effects of medications were well founded,
Turner had not communicated past symptoms to his care team and, on the whole, lacked
the capacity to make a reasoned decision.
Turner testified that he would not co nsent to neuroleptic medications because
“[t]here is no good effect from medications.” He claimed that taking one of the medications
in the past had resulted in weight gain and trouble sleeping and had yielded no benefits. As
to other potential neuroleptic medications, he stated that he would not consent to try a new
medication because he did not need it.

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The district court granted the petition from the bench at the close of the evidentiary
hearing. In its findings of fact, conclusions of law, and order that followed, the district court
found that that Dr. Erickson and the court-appointed examiner gave credible testimony.
The district court determined that Turner lacked insight into his schizophrenia and that he
could not determine whether neuroleptic me dication was reasonabl e and necessary. The
district court concluded that there were no ot her available alternative treatments, that the
benefits of treatment with neuroleptic medication clearly outweighed the risks and
intrusiveness, and that the treatment of Turner’s mental illn ess with neuroleptic
medications was reasonable and necessary. The district court’s order authorizes the
involuntary administration of five specific medications, in order to allow flexibility if
Turner does not respond well to one option, and directs that the two that have worked for
Turner in the past be tried first.
This appeal follows.
ISSUE
Did the district court err by authorizin g involuntary treatment with neuroleptic
medication without first considering whether to appoint a substitute decision-maker?
ANALYSIS
Turner argues that the district court sh ould have considered appointing a substitute
decision-maker before it authorized treatment with neuroleptic medications.
1 As an initial

1 DHS notes that Turner’s brief could poten tially be interpreted as also raising a
sufficiency-of-the-evidence argument—specifi cally, in the statement-of-the-issues
section—and it responds to such an argument “out of an abundance of caution.” But we do
not agree that Turner’s brief sh ows an intent to assert that issue, and, even if Turner

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matter, Turner did not raise the substitute-decision-maker issue in the district court. Minn.
Stat. § 253B.092, subd. 6, instructs that a substitute decision-maker shall be appointed by
the court “ [u]pon request of any person , and upon a showing that administration of
neuroleptic medications may be recommended and that the pe rson may lack capacity to
make decisions regarding the administrati on of neuroleptic medication.” (Emphasis
added.) Turner neither requested a substitute decision-maker nor argued that one should be
considered in connection with Dr. Erickson’s petition. Appellate courts generally will not
consider matters not argued to and considered by a district court. Thiele v. Stich , 425
N.W.2d 580, 582 (Minn. 1988). But this rule is not “ironclad.” Putz v. Putz, 645 N.W.2d
343, 350 (Minn. 2002). Because the issue presen ted is one of statutory interpretation that
does not depend on any disputed facts, and because DHS thoroughly briefed it, we consider
it here. See Watson v. United Servs. Auto. Ass’n , 566 N.W.2d 683, 687-88 (Minn. 1997)
(deciding new issue on appeal when the fact s were undisputed and the issue was raised
prominently in the appellate briefing, was an issue of first impression, and involved a
statute-based theory).
Turner argues that the structure of Mi nn. Stat. § 253B.092 requires that, before
judicial authorization to administer neurol eptic medication may be sought, the options

intended to raise it, an argument based on a mere assertion of error is forfeited. See
Szarzynski v. Szarzynski , 732 N.W.2d 285, 295 (Minn. Ap p. 2007). We thus decline to
evaluate a sufficiency-of-the-evidence argumen t in the absence of adequate briefing. See
In re Commitment of Kropp , 895 N.W.2d 647, 653 (Minn. App. 2017) (“Minnesota
appellate courts decline to reach an issu e in the absence of adequate briefing.”), review
denied (Minn. June 20, 2017).

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outlined in subdivision 2 to administer it without judicial review must first be exhausted.
See Minn. Stat. § 253B.092. One of those options is consent by a substitute decision-maker.
Statutory interpretation is a legal question subj ect to de novo review. In re Civil
Commitment of Ince , 847 N.W.2d 13, 20 (Minn. 2014). The purpose of statutory
interpretation is to determine the legislat ure’s intent. Minn. Stat. § 645.16 (2018). To
discern the legislature’s intent, courts look to the plain language of the statute and ask
whether the plain language is ambiguous. Christianson v. Henke, 831 N.W.2d 532, 536-37
(Minn. 2013). A statute is ambiguous if it is subject to multiple reasonable interpretations.
Id. at 537. We construe the words and phrases in the statute “according to rules of grammar
and according to their common and approved usage.” Rodriguez v. State Farm Mut. Auto.
Ins. Co., 931 N.W.2d 632, 634 (Minn. 2019) (quotation omitted). “In addition, the meaning
of a word is informed by how it is used in the context of a statute.” State v. Rogers, 925
N.W.2d 1, 3 (Minn. 2019). Accordingly, courts “consider a statute as a whole to harmonize
and give effect to all its parts.” Id. (quotation omitted).
If the statute is not ambiguous, courts apply its plain meaning and do not “explore
the spirit or purpose of the law.” Christianson, 831 N.W.2d at 537 (quotation omitted).
Similarly, if a statute omits words, courts “c annot read them into an unambiguous statute
under the guise of statutory interpretation.” In re Commitment of Breault, 942 N.W.2d 368,
377 (Minn. App. 2020) (quotation omitted).
Minn. Stat. § 253B.092 establishes rule s that govern the administration of
neuroleptic medication to patients subject to civil commitment as mentally ill. See Minn.
Stat. § 253B.092, subd.1. Treatment provide rs for these patients regularly recommend

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neuroleptic medication, which can reduce symptoms of psychosis. Breault, 942 N.W.2d at
373. If the patient lacks capacity or refuses to consent, treatment providers may seek a
judicial determination. Id.
Under section 253B.092, patients are presum ed to have capacity to make decisions
regarding neuroleptic medication. Minn. Stat. § 253B.092, subd. 5(a). If the district court
finds that the patient has capacity, the patient ’s wishes regarding neuroleptic medication
control. Id., subd. 8(d). If the district court finds that the patient lacks capacity, though, and
if the patient did not clearly st ate what they would choose to do at a ti me when they did
have capacity, the district court may determine whether a reasonable person would consent
to treatment with neuroleptic medication. Id., subds. 7, 8; see also Breault, 942 N.W.2d at
373. Subdivision 7 of secti on 253B.092 identifies relevant considerations for this
determination, including the patient’s values, the medical risks and benefits, and the past
efficacy of medications. Minn. Stat. § 253B.092, subd. 7(c).
Section 253B.092 also authorizes the ad ministration of neuroleptic medications
without district court involv ement in several specific s ituations, including when “a
substitute decision-maker appoint ed by the court consents to the administration of the
neuroleptic medication and the patient does not refuse administration of the medication.”
Id., subd. 2(4). Subdivision 6(a) explains how a substitute decision-maker is appointed:
Upon request of any person, and upon a showing that
administration of neurolep tic medications may be
recommended and that the person may lack capacity to make
decisions regarding the admi nistration of neuroleptic
medication, the court shall appoint a substitute decision-maker
with authority to consent to th e administration of neuroleptic
medication as provided in this section.

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Id., subd. 6(a). A substitute decision-maker mu st apply the same standards listed in
subdivision 7 that the district court ap plies when making deci sions regarding the
administration of neuroleptic medication. Id., subd. 6(b). While a substitute decision-maker
can withhold consent or can consent when the patient doe s not refuse, the substitute
decision-maker’s consent cannot override the patient’s refusal to take the medication. Id.,
subds. 2(4), 6(b).
Turner argues that the ordering of the subdi visions in section 253B.092 requires that
treatment providers like Dr. Erickson firs t pursue administration of neuroleptic
medications without judicial review under subd ivision 2, before pursuing a judicial order
for administration of neuroleptic medication under subdivisions 7 and 8. Turner contends
that interpreting the statute th is way would “set a more de fined procedure” and be less
intrusive on patients’ liberty interests.
DHS responds that nothing in the plain language of the statut e supports Turner’s
argument and that the language of the statute as a whole cuts against Turner’s proposed
interpretation. After a careful review of section 253B.092, we agree.
First, as DHS points out, the statute only provides for the appointment of a substitute
decision-maker “[u]pon the request of any person.” Id., subd. 6(a). Nowhere does it require
that a district court consider a substitute de cision-maker when there has been no request
for one. Additionally, the procedure that must be followed when a treatment provider seeks
judicial authorization to administer neur oleptic medication is clearly outlined in
subdivision 8. Subdivision 8 contains no requirement that the treatment provider first seek

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appointment of a substitute decision-maker be fore requesting judici al authorization. Id.,
subd. 8.
Second, language throughout section 253B .092 suggests that consideration of a
substitute decision-maker is not a necessary pr erequisite to judicial authorization to
administer neuroleptic medication. See, e.g., Minn. Stat. § 253B.092, subds. 6(d) (stating
that, at a hearing on a request for authorization to administer neuroleptic medication, “[i]f
a substitute decision-maker has been appointed by the court, the court shall make findings
regarding the patient’s capacity . . . and affirm or reverse its appointment of a substitute
decision-maker” (emphasis added)), 7(a) (“When a person lacks capacity to make decisions
regarding the administration of neuroleptic medication, the substitute decision-maker or
the court shall use the standards in this subdivi sion in making a decision regarding
administration of the medication.” (emphasis added)).
Third, interpreting the statute as Turner requests would create a futile requirement
in cases, such as this one, in which the pa tient actively refuses neuroleptic medication,
because a substitute decision-maker cannot override a patient’s express refusal. Id., subds.
2(4), 6(b). Even if the district court had appointed a substitute decision-maker, Dr. Erickson
could still have pe titioned for and the district court co uld still have granted the order for
the involuntary administration of neuroleptic medication.
In sum, Turner asks this court to read into Minn. Stat. § 253B.092 a procedural
requirement that is nowhere to be found in th e plain language of the statute. He contends
that doing so would afford greater protec tions to patients refu sing treatment with
neuroleptic medications. Even if this were tr ue, when a requirement is not present in a

10
statute, we will not “read [it] into an unam biguous statute under the guise of statutory
interpretation.” Breault, 942 N.W.2d at 377 (quotation omitted). And, while Turner claims
that the legislature may have intended to creat e such a procedural requirement in order to
protect patient rights, courts do not explore the purpose of a law in the absence of an
ambiguity. Christianson, 831 N.W.2d at 537. We accordingl y hold that the district court
did not err by failing to consider appointing a substitute decision-maker in this case.
Even if we were to interpret the statute as Turner requests, t hough, he would still
not be entitled to relief. If an appellant shows that the district court erred, the mere existence
of that error is, by itself, insufficient to requir e a grant of relief; the appellant must also
show that the error was prejudicial. See Minn. R. Civ. P. 61 (requiring harmless error to be
ignored); Goldman v. Greenwood, 748 N.W.2d 279, 285 (Minn. 2008) (citing this aspect
of rule 61); Kallio v. Ford Motor Co., 407 N.W.2d 92, 98 (Minn. 1987) (“Although error
may exist, unless the error is prejudicial, no grounds exist for reversal”).
Here, Turner contends that a substitute decision-maker should have been requested
or considered, but, as explained above, a substitute decision-maker does not have the
authority under Minn. Stat. § 253B.092 to override a patient’s refusal to accept neuroleptic
medications. Minn. Stat. § 253B.092, subds. 2(4), 6(b). Turner expressly refused any
neuroleptic medications. Thus, his treating physician’s only path to administering
medication was to petition for j udicial authorization, as he did. The appointment of a
substitute decision-maker would have change d nothing, and Turner has accordingly not
shown prejudice.

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D E C I S I O N
Because no one requested that the district court appoint a substitute decision-maker,
the district court did not e rr by ordering the involuntary ad ministration of neuroleptic
medications to Turner without first consideri ng a substitute decision-maker. And, even if
it was error, Turner has not shown prejudice.
Affirmed.