In the Matter of the Necessity of the Hospitalization of Lucy G.
448 P.3d 868
| Alaska | 2019Background
- Lucy G. was found catatonic, unable to care for basic needs, and involuntarily committed after hospital petitioning.
- Juneau and Fairbanks psychiatrists testified (qualified experts): psychotropic meds had not produced meaningful improvement; ECT had an estimated 80–90% response rate for catatonia and was recommended as the "least restrictive" effective treatment.
- Fairbanks operated the only active ECT program in Alaska; the proposed ECT would be administered under anesthesia with standard monitoring and known (generally transient) side effects.
- The superior court held a contested hearing, made oral findings applying Myers factors, and ordered a 30‑day commitment plus involuntary psychotropic medication and involuntary ECT.
- On appeal Lucy challenged (1) the use of Myers standards for ECT (arguing a heightened standard is required) and (2) the sufficiency/weighting of the court’s Myers‑factor findings.
- The Alaska Supreme Court reviewed the record (exercising independent judgment on mixed questions of law and fact) and affirmed the ECT order.
Issues
| Issue | Plaintiff's Argument (Lucy) | Defendant's Argument (State) | Held |
|---|---|---|---|
| Applicability of Myers standards to involuntary ECT | Myers protections are insufficient; ECT is more intrusive than meds and requires a heightened standard | Myers best‑interests / least‑intrusive framework applies to non‑emergency ECT as agreed below | Myers framework applies; no plain error in using it; heightened categorical rule not adopted |
| Constitutional test / burden | ECT implicates fundamental rights; state must show compelling interest and least restrictive means | State has parens patriae compelling interest; must show treatment is in patient’s best interests and no less intrusive feasible alternative | Court reiterated state must articulate compelling interest and show treatment is least restrictive; must find both best interests and least intrusive means by clear and convincing evidence |
| Sufficiency of superior court’s Myers‑factor findings | Court’s written findings were cursory; oral findings insufficiently specific or misweighed harms (e.g., memory loss, death risk) | Court made adequate oral findings addressing the Myers factors and relied on expert testimony; any minor gaps were harmless | Court made adequate findings on relevant, contested Myers factors; findings not clearly erroneous and supported ordering ECT |
| Least intrusive alternative | Court should have delayed to try meds or other less intrusive options; prior spontaneous recoveries argue for waiting | Experts testified meds had failed historically and currently; delay risked irreversible catatonia; alternatives not likely to satisfy compelling interest | Court reasonably found ECT was the least intrusive feasible option given evidence meds were ineffective and condition was deteriorating |
Key Cases Cited
- Myers v. Alaska Psychiatric Inst., 138 P.3d 238 (Alaska 2006) (establishes judicial best‑interests and no‑less‑intrusive alternative requirements and clear‑and‑convincing proof for nonemergency involuntary psychotropic treatment)
- Bigley v. Alaska Psychiatric Inst., 208 P.3d 168 (Alaska 2009) (clarifies feasibility and evidence‑based inquiry for less‑intrusive alternatives)
- Matter of C.D.M., 627 P.2d 607 (Alaska 1981) (sterilization decision premised on permanent infringement of procreative right; court distinguished C.D.M. from ECT)
- Ornelas v. United States, 517 U.S. 690 (U.S. 1996) (explains mixed questions of law and fact and supports de novo appellate review for certain mixed questions)
- Bose Corp. v. Consumers Union of U.S., Inc., 466 U.S. 485 (U.S. 1984) (applies independent appellate review where constitutional stakes are high and mixed questions arise)
- In re Hospitalization of Naomi B., 435 P.3d 918 (Alaska 2019) (discusses required findings and clarifies application of Myers factors)