Jarvis v. Levine

418 N.W.2d 139, 74 A.L.R. 4th 1079, 1988 Minn. LEXIS 3, 1988 WL 1239
CourtSupreme Court of Minnesota
DecidedJanuary 15, 1988
DocketC2-86-1633
StatusPublished
Cited by66 cases

This text of 418 N.W.2d 139 (Jarvis v. Levine) is published on Counsel Stack Legal Research, covering Supreme Court of Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Jarvis v. Levine, 418 N.W.2d 139, 74 A.L.R. 4th 1079, 1988 Minn. LEXIS 3, 1988 WL 1239 (Mich. 1988).

Opinions

OPINION

YETKA, Justice.

Appellant Homer Jarvis seeks review of a decision of the court of appeals which held that involuntary treatment with neuro-leptic drugs was not an intrusive treatment per se and thus did not require court approval to administer under the procedural requirements of Price v. Sheppard, 307 Minn. 250, 239 N.W.2d 905 (1976). He also seeks review of the court’s determination that his claim for post-medication review and damages is moot.

We reverse the court of appeals in part, affirm in part and remand.

I.

Homer Jarvis was indeterminately committed to the Minnesota Security Hospital in March 1977 as mentally ill and dangerous after the shooting death of his sister. He was convicted of manslaughter for the death and has served and been discharged from his sentence.

During his period of commitment, Jarvis has been involuntarily treated with major tranquilizers or neuroleptic medication1 four times. This case involves only the most recent course of treatment, which began in December 1984 and ended in September 1985.

The diagnosis of Jarvis’ mental illness is not clear. Although the court of appeals concluded that he had been diagnosed as paranoid schizophrenic, the record seems to indicate the more appropriate diagnosis to be paranoid state because Jarvis lacks hallucinations. Jarvis denies that he is ill or requires professional help and believes that hospital personnel and the courts have conspired to commit him indefinitely. He also believes that the medications he receives [141]*141are poisoning him. However, Jarvis is articulate and intelligent and his self-care skills are intact. The record contains no evidence that Jarvis is currently violent. The question of involuntary medication in emergency situations is, therefore, not before the court. Jarvis has apparently been quite a difficult patient, at times refusing to cooperate in treatment programming, group therapy, individual counseling, or psychological interviews. He has been caustic, derogatory and sarcastic in his interactions with the hospital staff.

A.Prior Involuntary Treatment

Jarvis was first treated with neuroleptic medication (Prolixin) in March 1977, shortly after his commitment. He immediately complained of tremors, blurred vision, tiredness and difficult urination. Jarvis’ treating physician, concerned over Jarvis’ severe side effects, also doubted that significant progress would be made with medication. He discontinued treatment in the summer of 1978.

In November 1978, a second course of neuroleptic treatment was begun. Because Jarvis’ doctor noted “significant side effects” from Prolixin, a different drug (Na-vane) was used. Jarvis then developed severe akathesia. Akathesia refers to strong subjective feelings of distress or restlessness which cause a compelling need for the patient to be in constant motion. The patient may attempt to obtain relief by constant, repetitive motions primarily of the extremities. See Goodman & Gilman, The Pharmacological Basis of Therapuetics 405-06 (7th ed. 1985). Because of Jarvis’ discomfort, the medication was changed to Serentil. Respondent Dr. Doheny, then a psychiatric consultant, discontinued neuro-leptic medication in February 1980 due to Jarvis’ “severe akasthisia [sic] and lack of symptoms.” Jarvis remained off medications for nearly 1 year. The physical side effects improved and there was apparently no significant deterioration in his mental condition.

In February 1981, a third course of involuntary treatment was begun, continuing until May 1982. By September 1981, Jarvis was strongly requesting discontinuance. Dr. Paul Melchiar, M.D., a psychiatric consultant, found “no clear-cut evidence that he has benefited from medication.” In May 1982, Dr. Melchiar concluded that Jarvis was “within his legal rights to refuse medication” and discontinued neuroleptic treatment. Jarvis remained off neurolep-tics for 2½ years until December 1984. There is no evidence that it has been necessary to medicate Jarvis in an “emergency” during his periods off medication. The emergency procedures are thus not at issue in the present case.

B. Most Recent Course of Treatment

In November 1984, respondent Dr. Dohe-ny, Jarvis’ treating physician, initiated a request for involuntary treatment. The involuntary medication policy contained in the Institutions Manual Guidelines, which was promulgated by the Department of Public Welfare in 1981, was followed because Jarvis refused treatment. Jarvis’ claim is based primarily on his contention that the policy procedures do not sufficiently protect his rights under Minnesota and federal law. In addition, he contends that the procedures have not been properly followed in his case and warrant a hearing on. his claim for damages.

C. Manual Involuntary Medication Policy

The policy manual sets forth both substantive and procedural requirements for involuntary medication treatment cases.

Substantive Requirements

In non-emergency cases before involuntary treatment with neuroleptic drugs may begin, two elements must be established:

a. The patient lacks the ability to engage in a rational decision-making process regarding the acceptance of treatment and is unable to weigh the possible benefits and risks of treatment (the mere fact of disagreement about medication does not in itself constitute evidence of inability); and
b. The patient’s behavior has been observed and documented and the patient is found to be suffering from a major men[142]*142tal illness with severe functional incapacity * * *.

Section XII-4030, 2.a., 2.b. After these elements have been established, one of the two following conditions must also be found before treatment can begin:

(1) The patient has a documented history of clearly demonstrated reductions of symptoms during previous treatment with the [drug] and of clearly demonstrated deterioration of function when the [drug] was discontinued; or
(2) The nature of the documented behavior of a committed patient is sufficiently severe and of such duration that the known benefits clearly outweigh the possible risks of the medication.

Section XII-4030, 2.c.(l), (2) (emphasis added).

If the second condition has been met, neuroleptics may be administered for a trial period, but:

(a) The trial may not exceed 30 days in length; and
(b) At the end of 30 days the treatment will be evaluated by the treatment team, and if the evaluation establishes the efficacy of the [drug] for that patient (using the criteria in XII-4030, 2.e.(l) above), the treatment team may initiate another request for involuntary administration of the [drug] for that patient.

Section XII-4030, 2.c.(2)(a), (b).

In assessing the risks and benefits of forced medication, the manual requires consideration of “the possible non-physical side effects * * * such as anger, fear, and dis-trustfulness which may result from involuntary administration of medication.” Section XII-4030, 2.c.(3).

Procedural Requirements

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Bluebook (online)
418 N.W.2d 139, 74 A.L.R. 4th 1079, 1988 Minn. LEXIS 3, 1988 WL 1239, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jarvis-v-levine-minn-1988.