524 P.3d 795
Alaska2023Background
- Tonja P., with a long history of schizophrenia and six prior commitments to API, stopped taking medication and deteriorated in March 2021, becoming unable to care for herself and at times aggressive; she was admitted to the Alaska Psychiatric Institute (API) and then refused medication.
- API sought and received a court evaluation order and then filed 30-day commitment and involuntary psychotropic medication petitions; Dr. Laura Swogger (treating psychiatrist) testified for API about Tonja’s psychosis, need for medication, and lack of viable outpatient alternatives.
- A court visitor was appointed to assess capacity and investigate any prior competent refusals or advance directives; the visitor testified Tonja lacked capacity, denied illness, and that no advance directive had been located after attempts to contact Tonja’s father.
- The superior court granted the 30-day commitment and authorized involuntary medication (risperidone, with haloperidol backup), finding Tonja lacked capacity, medication was in her best interest, and no less restrictive alternatives were available.
- API later obtained a 90-day commitment and continued medication authorization as Tonja transitioned toward long‑acting injectable medication; Tonja appealed the 90‑day commitment and medication orders.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether commitment to API was the least restrictive alternative | Tonja: assisted living or other less restrictive facilities were available and commitment to API was unnecessary | State/API: assisted living and outpatient programs were not feasible (couldn’t involuntarily administer injectable meds or prevent elopement); no suitable programs would accept her level of need | Affirmed — court reasonably found no less‑restrictive available alternative given expert testimony and safety concerns |
| Whether reliance on the court visitor’s allegedly cursory report was reversible error | Tonja: visitor’s investigation was minimal (only unsuccessful contact attempts) and court’s reliance was plain error because prior competent refusals or directives were not adequately investigated | State/API: visitor attempted contact; treating physician had spoken with parents; Tonja’s communication limits and prior commitments made discovering directives unlikely; any insufficiency was not obviously prejudicial | Affirmed — not plain error; court’s reliance on the visitor was not obviously prejudicial in context |
| Whether the court made required specific findings that medication was in Tonja’s best interests | Tonja: court failed to make specific Myers-factor findings about risks, side effects, and reasonable alternatives | State/API: court heard and credited testimony about low risk, monitoring plans, past successful response, and lack of acceptable alternatives | Affirmed — court made adequate findings and addressed risks, monitoring, benefits, and alternatives per Myers requirements |
Key Cases Cited
- In re Hospitalization of Naomi B., 435 P.3d 918 (Alaska 2019) (least‑restrictive‑alternative availability test)
- Myers v. Alaska Psychiatric Inst., 138 P.3d 238 (Alaska 2006) (visitor duties and mandatory factors for involuntary medication)
- Wetherhorn v. Alaska Psychiatric Inst., 156 P.3d 371 (Alaska 2007) (court visitor’s report is an essential part of the statutory scheme)
- Bigley v. Alaska Psychiatric Inst., 208 P.3d 168 (Alaska 2009) (an alternative must be actually available to satisfy state interests)
- In re Hospitalization of Connor J., 440 P.3d 159 (Alaska 2019) (plain‑error review standard for first‑raised issues on appeal)
- In re Hospitalization of Gabriel C., 324 P.3d 835 (Alaska 2014) (plain‑error standard discussion)
- In re Hospitalization of Lucy G., 448 P.3d 868 (Alaska 2019) (requirement to make specific Myers findings before involuntary medication)
- In re Hospitalization of Danielle B., 453 P.3d 200 (Alaska 2019) (deference to factfinder credibility determinations)