In the Matter of the Civil Commitment of: Nicholas Scott Thompson.

This opinion is nonprecedential except as provided by
Minn. R. Civ. App. P. 136.01, subd. 1(c).

STATE OF MINNESOTA
IN COURT OF APPEALS
A25-0117

In the Matter of the Civil Commitment of: Nicholas Scott Thompson.

Filed September 15, 2025
Affirmed
Schmidt, Judge

Jackson County District Court
File No. 32-PR-20-17

Chris Reisdorfer, Nelson Oyen Torvik P.L.L.P., Montevideo, Minnesota (for appellant
Nicholas Scott Thompson)

Keith Ellison, Attorney General, Anthony R. Noss, Assistant Attorney General, St. Paul,
Minnesota (for respondent Kelly Jarcho, APRN, CNP)

Considered and decided by Schmidt, Presiding Judge; Connolly, Judge; and Segal,
Judge.
∗
NONPRECEDENTIAL OPINION
SCHMIDT, Judge
Appellant Nicholas Scott Thompson challenges a district court’s decision
authorizing his care providers to administer neuroleptic medication without his consent
under Minn. Stat. § 253B.092 (2024). Because the record supports the district court’s
findings of fact, we affirm.

∗ Retired judge of the Minnesota Court of Appeals, serving by appointment pursuant to
Minn. Const. art. VI, § 10.
2
FACTS
Thompson is subject to an indeterminant civil commitment as a person who has a
mental illness and is dangerous to the public. He has been diagnosed with delusional
disorder— persecutory type. Thompson’s civil commitment began after he allegedly killed
his mother. The state charged him in September 2018 with second -degree intentional
murder and two counts of second-degree unintentional felony murder. The district court
initially declared Thompson incompetent to stand trial, but his competency has been a
recurring issue in his criminal case and the subject of multiple appeals. See State v.
Thompson, 988 N.W.2d 149, 151-52 (Minn. App. 2023), rev. denied (Jun. 20, 2023) .
Thompson resides at the St. Peter Regional Treatment Center where he receives care under
the forensic mental health program. Respondent Kelly Jarcho is a psychiatric mental health
nurse practitioner and is Thompson’s psychiatric provider.
Throughout his civil commitment, Thompson has had a history of refusing
medication prescribed by his care providers. The district court has, at least twice,
authorized Thompson’s care providers to administer neuroleptic medication without his
consent, which this court affirmed on appeal. See In re Civ. Commitment of Thompson ,
No. A20-1246, 2021 WL 955955 (Minn. App. Mar. 15, 2021) (affirming order authorizing
involuntary administration of neuroleptic medication); In re Commitment of Thompson,
No. A21-0940, 2021 WL 5872661 (Minn. App. Dec. 13, 2021) (same).
In June 2023, an order authorizing administration of neuroleptic medication expired.
Afterward, Thompson stopped taking the medication. In November 2023, the district court
in Thompson’s criminal case deemed him competent to stand trial.
3
In September 2024, Thompson executed a health-care directive in which he
appointed a friend to make decisions on his behalf should he be unable to speak for himself.
In the directive, Thompson stated that, if he could not speak for himself, he “would want
[t]o remain free from the implication of any treatment not specified by this Directive. No
neuroleptic, electro-shock, or experimental treatments.”
Thompson’s mental-health symptoms grew worse after he stopped taking the
medication. In October 2024, Thompson’s psychiatric provider petitioned the district court
to authorize the administration of neuroleptic medication without Thompson’s consent.
The court held a Jarvis hearing1 and heard testimony from the psychiatric provider, a
forensic examiner, and Thompson.
The psychiatric provider testified that she has been treating Thompson since
October 2022 and is familiar with his medical history. Thompson’s diagnosis has remained
consistent throughout the provider’s time treating him. According to the psychiatric
provider, Thompson believes that people are conspiring against him and that he is in civil
commitment because the state does not have the evidence to convict him on his criminal
charges. While Thompson was taking neuroleptic medication, the psychiatric provider
“did not see any delusional content, his mood was better[,]” and the provider was able to
manage the medication’s negative side effects. However, because Thompson did not
exhibit symptoms of his disorder while on the medication, the psychiatric provider testified

1 A “Jarvis hearing” is a hearing at which the district court addresses whether it will
approve the administration of medication without a patient’s consent. See Jarvis v. Levine,
418 N.W.2d 139, 150 (Minn. 1988).
4
that she did not have a strong basis to renew the order requiring Thompson to take the
medication. The psychiatric provider wanted clarity as to whether the medication
continued to be necessary. Therefore, she permitted the order to expire.
The psychiatric provider testified that Thompson has not progressed in his treatment
since he stopped taking the neuroleptic medication. Thompson’s symptoms grew worse
without the medicaton, despite the availability of mental health groups and therapy.
Without neuroleptic medication, the psychiatric provider believed that Thompson’s
prognosis was poor and that he would not progress in his treatment. By comparison, with
neuroleptic medication, she expected him to benefit greatly. She testified that there are no
viable less-intrusive treatments that would stabilize Thompson and that she was unaware
of any family, community, religious, or social value-reason that would prevent Thompson
from taking the medication. Although the psychiatric provider was aware of Thompson’s
health care directive, she testified that Thompson lacks insight into his mental illness and
is incapable of rationally weighing the benefits and risks of neuroleptic medication.
The forensic examiner testified and agreed with Thompson’s diagnosis for
delusional disorder. The examiner testified that Thompson has “a strong sense of
persecution and unfair . . . treatment by others ” and his rationale for refusing neuroleptic
treatment does not align with reality. The examiner agreed that neuroleptic medication is
in Thompson’s best interests and is the only way for him to progress in a hospital setting.
Thompson testified last and explained that he named a friend as his agent on the
health care directive and that he discussed his feelings about neuroleptic medication with
her. Thompson stated that he objected to taking the neuroleptic medication because “the
5
vast majority of . . . the claims made against me are . . . unaffirmable,” and asserted that he
had only “negative physical side effects[]” when he took the medication in the past.
In November 2024, the district court filed an order in which it authorized the
administration of neuroleptic medication without Thompson’s consent. The district court
found that Thompson lacked capacity to make decisions about neuroleptic medication
because he: (1) lacks awareness about “the possible consequences of refusing treatment
with neuroleptic medication”; (2) “cannot state the benefits of medication”; and (3) “[h]is
decision regarding his treatment with neuroleptic medication is affected by and clouded by
his lack of insight into his mental illness.”
The district court also found that “it is both reasonable and necessary that Thompson
be treated with neuroleptic medication at this time.” The court stated that “[w]ithout
neuroleptic medication it is unlikely that Thompson would ever be able to move forward
to a less restrictive environment [,]” and “the benefits of treatment with neuroleptic
medication clearly outweigh the risks and intrusiveness of treatment.” The district court
found “there is no less restrictive alternative treatment.” Finally, the district court noted
that “Thompson’s objection to the medication is based on his belief that he is not mentally
ill. There is no evidence that he is objecting based on moral, religious, or social values.”
After the district court filed its order, Thompson filed a motion to reconsider, which
the district court denied. Thompson appeals from the district court’s order authorizing the
administration of neuroleptic medication without his consent.
2

2 Thompson does not contest the district court’s decision to deny his motion to reconsider.
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DECISION
Upon request, and after a hearing, a district court may file an order permitting a
treatment facility to administer neuroleptic medication to a civil- commitment patient
without the patient’s consent. Minn. Stat. § 253B.092, subd. 8. A district court may grant
such authorization “[i]f the court finds that the patient lacks capacity to decide whether to
take neuroleptic medication and has applied the standards set forth in subdivision 7.” Id.,
subd. 8(e). Under subdivision 7, the district court must consider whether the patient —
while having capacity —clearly expressed any wishes regarding neuroleptic medication
and whether administering neuroleptic medication is reasonable. Id., subd. 7; In re Civ.
Commitment of Breault, 942 N.W.2d 368, 377-79 (Minn. App. 2020).
When a district court authorizes the administration of neuroleptic medication
without a patient’s consent, “we review the record in the light most favorable to the district
court’s decision.” In re Civ. Commitment of Raboin, 704 N.W.2d 767, 769 (Minn. App.
2005). “We will affirm the district court’s findings unless they are clearly erroneous.” Id.
Our clear error standard of review requires that we (1) view the evidence in the light most
favorable to the district court’s findings, (2) do not find our own facts, (3) do not reweigh
the evidence, and (4) do not “reconcile conflicting evidence.” In re Civ. Commitment of
Kenney, 963 N.W.2d 214, 221-22 (Minn. 2021) (quotation omitted).
On appeal, Thompson argues that the district court (1) clearly erred in finding that
he lacked capacity to make decisions regarding neuroleptic medication; (2) failed to
consider his wishes from the healthcare directive; and (3) clearly erred in finding that
neuroleptic medication is reasonable and necessary. We address each argument in turn.
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I. The district court did not clearly err when it found that Thompson lacked
capacity to make decisions regarding neuroleptic medication.

Thompson argues that the district court clearly erred in finding that he lacked
capacity to decide whether to take neuroleptic medication. A patient enjoys “a rebuttable
presumption that [they have] the capacity to make decisions regarding the administration
of neuroleptic medication.” Minn. Stat. § 253B.092, subd. 5(a). A patient has capacity if
the patient:
(1) has an awareness of the nature of the patient’s situation,
including the reasons for hospitalization, and the
possible consequences of refusing treatment with
neuroleptic medications;

(2) has an understanding of treatment with neuroleptic
medications and the risks, benefits, and alternatives; and

(3) communicates verbally or nonverbally a clear choice
regarding treatment with neuroleptic medications that is
a reasoned one not based on a symptom of the patient’s
mental illness, even though it may not be in the patient’s
best interests.

Id., subd. 5(b). A “petitioner has the burden of proving incapacity by a preponderance of
the evidence.” Id., subd. 6(d); In re Civ. Commitment of Froehlich, 961 N.W.2d 248, 252-
53 & n.3 (Minn. App. 2021). “A finding of lack of capacity under [section 253B.092] must
not be construed to determine the patient’s competence for any other purpose.” Minn. Stat.
§ 253B.092, subd. 8(f).
Thompson challenges the district court’s finding as to each of the three statutory
factors and raises a separate argument related to the competency finding in the criminal
case. First, Thompson argues that the district court clearly erred under subdivision 5(b)(1)
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when it found that he “does not demonstrate an awareness of the possible consequences of
refusing treatment with neuroleptic medication[.]” Thompson points to testimony in which
his psychiatric provider described Thompson showing an awareness of his diagnosis by
sometimes choosing not to answer questions that might provoke him to express his
delusions in front of her. But viewed in the light most favorable to the district court’s
decision, even if the psychiatric provider’s testimony shows that Thompson has some
awareness of his diagnosis, the provider also testified that Thompson is unaware that the
symptoms of his serious mental illness became worse when he ceased taking the
neuroleptic medication.
Thompson also points to testimony in which the examiner described him as “a very
bright gentleman [who] has a lot of awareness, and . . . ability to understand things[,]” and
is not at risk of harming others. The examiner also testified, however, that Thompson lacks
an understanding of the nature of his situation regarding neuroleptic medication. The
examiner opined that neuroleptic medication is in Thompson’s best interests and is the only
way for him to progress in a hospital setting. The import of the examiner’s testimony is
that Thompson needs neuroleptic medication to treat his mental illness but refuses to take
the medication because of the illness itself. The district court’s finding under subdivision
5(b)(1) was not clearly erroneous.
Second, Thom pson argues that the district court clearly erred under subdivision
5(b)(2) when it found that, although “Thompson can state the risks, . . . he cannot state the
benefits of medication.” But the record demonstrates that Thompson never entertained the
possibility that the medication would benefit him. Instead, Thompson stated that, when he
9
took the medication before, he had only “negative physical side effects.” The psychiatric
provider’s testimony established that she was able to manage negative side effects when
Thompson was on the medication in the past. Taking this evidence in the light most
favorable to the district court’s decision, the court’s finding under subdivision 5(b)(2) was
not clearly erroneous.
Third, Thompson argues that the district court clearly erred under subdivision
5(b)(3) when it failed to find that he communicated “a clear choice regarding treatment
with neuroleptic medication[]” in his health-care directive. However, the statute requires
that a patient’s clear choice must be “a reasoned one not based on a symptom of the
patient’s mental illness.” Minn. Stat. § 253B.092, subd. 5(b)(3). Here, the district court’s
findings are supported by the testimony of the psychiatric provider and the examiner, both
of whom testified that Thompson refused medication while suffering from delusions that
people were conspiring against him. Accordingly, the district court found that “[h]is
decision regarding his treatment with neuroleptic medication is affected and clouded by his
lack of insight into his mental illness.” The district court’s finding under subdivision
5(b)(3) was not clearly erroneous.
Finally, Thompson argues that the district court’s incapacity finding is clearly
erroneous because the district court found him competent to stand trial in his criminal case.
However, section 253B.092 sets out a unique statutory scheme regarding involuntary
administration of neuroleptic medication that is distinct from a competency-inquiry in a
criminal case. The statute itself makes clear that a finding of incapacity under section
253B.092 “must not be construed to determine the patient’s competence for any other
10
purpose.” Minn. Stat. § 253B.092, subd. 8(f). And Thompson does not cite any authority
for the contention that competency to stand trial in a criminal matter requires that a person
be ruled competent for purposes of civil commitment.
The district court did not clearly err when it found that Thompson lacked “capacity
to make decisions regarding the administration of neuroleptic medication.”
II. The district court did not clearly err when it found that Thompson lacked
capacity at the time he executed the health care directive.

Thompson argues that the district court failed to consider his clearly expressed
wishes regarding neuroleptic medication in his health-care directive. When a
nonconsenting patient lacks capacity, a district court must follow the patient’s wishes on
whether to administer neuroleptic medication “[i]f the patient clearly stated what the
patient would choose to do in this situation when the patient had the capacity to make a
reasoned decision[.]” Minn. Stat. § 253B.092, subd. 7(b).
The district court found that “Thompson completed a health care directive” and
designated a person to “follow his wishe[s] on the use of neuroleptic treatment.” The
district court also found that Thompson lacked capacity to make decisions regarding
neuroleptic medication. In the order denying Thompson’s motion for reconsideration, the
district court again noted the existence of the health-care directive , but again found “that
Thompson lacked the capacity to make a decision regarding the administration of
neuroleptic medications.” When we view the record in the light most favorable to the
district court’s decision, we conclude that the court’s finding with regard to Thompson’s
capacity encompassed the time during which Thompson executed the health-care directive.
11
At the time Thompson executed his health-care directive, the evidence established that he
was off his medication and his symptoms were growing worse. Given the breadth of
evidence in the record about Thompson’s condition, the district court’s finding that
Thompson lacked capacity with regard to the administration of neuroleptic medications
was not clearly erroneous.
III. The district court did not clearly err when it found that neuroleptic medication
was reasonable and necessary for Thompson.

Thompson also argues that the district court clearly erred when it found that
neuroleptic medication was reasonable and necessary. “If evidence of the patient’s wishes
regarding the administration of neuroleptic medications is conflicting or lacking, the
decision must be based on what a reasonable person would do[.]” Minn. Stat. § 253B.092,
subd. 7(c). A district court must consider: “(1) the patient’s family, community, moral,
religious, and social values; (2) the medical risks, benefits, and alternatives to the proposed
treatment; (3) past efficacy and any extenuating circumstances of past use of neuroleptic
medications; and (4) any other relevant factors.” Id. A petitioner must present clear and
convincing evidence that neuroleptic medication is necessary and that a reasonable person
would consent to taking the medication. Breault, 942 N.W.2d at 378. Thompson argues
that the district court inadequately considered the second and third factors under Minnesota
Statutes section 253B.092, subdivision 7(c).
Regarding the second factor, Thompson argues that there were less-restrictive
treatments than neuroleptic medication. The statute does not, however, require a
consideration of less-restrictive treatments. Minn. Stat. § 253B.092, subd. 7(c)(2). Instead,
12
a district court must consider “the medical risks, benefits, and alternatives to the proposed
treatment[.]” Id. Here, the record evidence established that Thompson’s symptoms
became worse when he stopped taking the medication. The psychiatric provider testified
that there was no viable alternative to neuroleptic medication. Thus, the district court’s
finding that there is no “alternative treatment[]” was not clearly erroneous.
Regarding the third factor, Thompson argues that his prior use of neuroleptic
medication had only negative side effects and that the psychiatric provider’s delay in filing
the petition afte r the last order expired suggests that he was doing well without the
medication. Again, the record reflects that the psychiatric provider testified that she was
able to manage the negative side effects when Thompson was on the medication. She also
testified that Thompson’s symptoms grew worse without the medication. The district
court, therefore, did not clearly err when it found this factor weighs in favor of the
determination that the medication was that “[i]t is both reasonable and necessary” for
Thompson to receive neuroleptic medication.
Affirmed.