In re I.G., 153 A.3d 532

I.G., a 32-year-old with schizophrenia, was involuntarily hospitalized at VPCH in April 2016 after an arrest; he had a prior VPCH admission (May–July 2015) during which a prior petition to involuntarily medicate was denied.
While living at Soteria House after the 2015 discharge, I.G. completed a handwritten form expressing a firm preference to refuse psychiatric medications and setting non-medication interventions as priorities; the form lacked two required witnesses and thus did not meet the statutory advance-directive formalities.
The State sought a 90-day court order to involuntarily medicate I.G.; at the May 2016 hearing the State presented the treating psychiatrist, and I.G. and a Soteria House staff person testified for I.G.
The treating psychiatrist testified I.G. displayed persecutory delusions, disorganized thought, and that I.G.’s refusal was a product of his illness such that medication would likely ameliorate dangerous behavior.
The trial court found I.G. not competent under 18 V.S.A. § 7625(c) to refuse medication, concluded his refusal stemmed from delusional beliefs, gave the advance-preference form limited weight, and authorized involuntary medication for 90 days; I.G. appealed and obtained a stay.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether the trial court applied the proper competency standard under 18 V.S.A. § 7625(c) when ordering involuntary medication	Trial court used an overly demanding standard, failed to make required findings, and ignored evidence supporting I.G.’s competency	Court applied the statutory competency inquiry (ability to decide and appreciate consequences) and relied on credible findings that I.G.’s beliefs were delusional and impaired appreciation	Affirmed as to competency: trial court applied correct standard and findings support conclusion that I.G. was not competent to refuse medication
Whether the July 2015 written statement constituted a "competently expressed written . . . preference[] regarding medication" under 18 V.S.A. § 7627(b) entitled to deference	I.G. argued the written form reflected a competent, considered refusal and should be followed unless the Commissioner shows no clinical improvement from that preference	State argued the court could displace the preference by showing it had not led to significant clinical improvement; trial court treated the form as only probative of refusal and did not decide competency at time of signing	Reversed and remanded: trial court failed to make findings whether the 2015 written expression was competently made and whether § 7627(b)’s exception (no significant clinical improvement) applies; must address these issues on remand

In re T.C., 940 A.2d 706 (discussing deference to trial court findings in involuntary-medication appeals)
In re L.A., 912 A.2d 977 (competency inquiry requires specific findings on patient’s ability to appreciate consequences of refusing medication)
Peckham v. Peckham, 543 A.2d 267 (trial court’s credibility assessments and factual findings are owed deference)
Bull v. Pinkham Eng’g Assocs. Inc., 752 A.2d 26 (findings upheld if supported by credible evidence despite contrary evidence)
N. Sec. Ins. Co. v. Perron, 777 A.2d 151 (appellate court will not engage in fact-finding to supply missing trial-court findings)
In re Rumsey, 59 A.3d 730 (remand required where agency/court failed to make findings on a material issue)