In re G.G., 165 A.3d 1075

Background

G.G., diagnosed with schizophrenia and inpatient at Vermont Psychiatric Care Hospital since Sept. 2015, was subject to repeated involuntary-medication orders and a State application for continued treatment and involuntary bimonthly Prolixin injections.
Shortly before the consolidated hearing on continued treatment and involuntary medication, G.G. sought to dismiss his appointed counsel and proceed pro se; counsel also moved to withdraw. The family court denied both motions after a colloquy and found the waiver not knowing, intelligent, and voluntary and not in G.G.’s best interest.
The family court heard testimony from only two witnesses: G.G. and his treating psychiatrist, Dr. Alisson Richards, whose testimony the court found fully credible.
The court found by clear-and-convincing evidence that G.G. has schizophrenia, lacks insight, is not competent to refuse medication, poses danger to self and others (including history of catatonia and violence), and would likely deteriorate if Prolixin were discontinued.
The court ordered one year of continued hospitalization and involuntary administration of long-acting Prolixin every two weeks, subject to weekly reviews. G.G. appealed, challenging (1) the denial of self-representation and (2) the sufficiency of evidence for refusal, competency, and the statutory § 7627 factors supporting involuntary medication.

Issues

Issue	Plaintiff's Argument (G.G.)	Defendant's Argument (State)	Held
Right to self-representation in involuntary commitment/medication proceedings	G.G. asserted a due-process right to waive counsel and represent himself to preserve autonomy and dignity.	State argued no such right in civil mental-health proceedings and that late motions would cause delay.	Due process does not permit waiver of counsel here; the court properly denied self-representation. Patients retain participatory rights (testify, limited questioning/closing) but not pro se representation.
Sufficiency of evidence that patient was "refusing" medication (statutory prerequisite)	G.G. argued the State failed to show present refusal because he was not asked near the application whether he would accept injections voluntarily.	State relied on circumstantial evidence of longstanding refusal, active interference with administration, and testimony that he would discontinue medication if released.	Circumstantial evidence was sufficient under clear-and-convincing standard; direct contemporaneous questioning better practice but not required here.
Competency standard for refusing medication	G.G. argued the court applied an incorrect or overbroad competency standard, relying on diagnosis rather than decisionmaking ability.	State relied on statutory standard—whether patient can understand and appreciate consequences—and Dr. Richards’s testimony that G.G. could not balance risks/benefits.	Court applied correct statutory competency inquiry (ability to make and appreciate consequences) and reasonably found G.G. incompetent to refuse.
Merits under § 7627 (risks/benefits, alternatives, long-acting medication)	G.G. contended benefits insufficient, alternatives effective, and risks/side effects weighed against involuntary Prolixin.	State presented expert testimony that Prolixin produced marked improvement, alternatives were ineffective, side effects manageable, and long-acting form reduced conflict and improved outcomes.	The factfinder reasonably concluded by clear-and-convincing evidence that benefits outweighed risks, no less-restrictive alternative existed, and long-acting Prolixin was warranted.

Key Cases Cited

Faretta v. California, 422 U.S. 806 (1975) (recognized constitutional right of self-representation in criminal prosecutions and articulated underlying rationales)
Indiana v. Edwards, 554 U.S. 164 (2008) (permitted courts to require counsel when defendant lacks mental capacity for self-representation)
Martinez v. Court of Appeal of California, 528 U.S. 152 (2000) (no right to self-representation on appeal)
Addington v. Texas, 441 U.S. 418 (1979) (civil commitment requires clear-and-convincing proof)
Vitek v. Jones, 445 U.S. 480 (1980) (compelled transfer/conditions implicate liberty and bodily integrity)
Sell v. United States, 539 U.S. 166 (2003) (heightened scrutiny for involuntary medication where liberty and bodily integrity are implicated)
Morrissey v. Brewer, 408 U.S. 471 (1972) (Matters of what process is due depend on balancing private and governmental interests)
Washington v. Harper, 494 U.S. 210 (1990) (procedural protections for involuntary antipsychotic medication in prisons)
In re L.A. I, 181 Vt. 34 (Vt. 2006) (describing competency inquiry for involuntary medication)
In re E.T., 177 Vt. 405 (Vt. 2004) (due process protections in involuntary commitment proceedings)