Matter of Derius L

Opinion

2026 WL 2673474

Only the Westlaw citation is currently available.

NOTICE: THIS DECISION DOES NOT SERVE AS PRECEDENT. THE CASE WAS ENTERED IN THE WESTLAW DATABASE BEFORE THE TIME FOR REHEARING HAD EXPIRED. IT IS POSSIBLE THAT REHEARING HAS BEEN SOUGHT, GRANTED OR DENIED.

Supreme Court of Alaska.

In the MATTER OF the Necessity of the Hospitalization of: DERIUS L.

Supreme Court No. S-19058

September 11, 2026

Appeal from the Superior Court of the State of Alaska, Third Judicial District, Anchorage, The Honorable Adolf V. Zeman, Judge. Superior Court No. 3AN-24-00192PR

Attorneys and Law Firms

Lindsey Bray, Assistant Public Defender, and Terrence Haas, Public Defender, Anchorage, for Appellant.

Maxwell Jenkins-Goetz, and Laura Wolff, Assistant Attorneys General, Anchorage, and Treg Taylor, Attorney General, Juneau, for Appellee.

Before: Carney, Chief Justice, and Borghesan, Henderson, and Pate, Justices. [Oravec, Justice, not participating.]

OPINION

HENDERSON, Justice.

I. INTRODUCTION

Star page 1*1 A man appeals his involuntary commitment for mental health treatment and the involuntary administration of psychotropic medication. He argues for the first time on appeal that the superior court erred in committing him despite the petitioning hospital's failure to comply with the requirement that he first be allowed to refuse voluntary treatment. He also challenges the superior court's findings that there was no less restrictive alternative to commitment available. Finally, he argues the court erred in overriding his right to refuse the involuntary administration of psychotropic medications. Seeing no plain error, we affirm the superior court's orders on commitment and involuntary medication.

II. FACTS AND PROCEEDINGS

A. Derius's Health And Hospitalization History

Derius L.¹ is a person experiencing homelessness who has been expelled from various facilities and diagnosed with schizoaffective disorder bipolar type; traumatic brain injury (TBI); and polysubstance dependence. Prior to the matter at issue, Derius had been admitted to Alaska Psychiatric Institute (API) 42 times.

When Derius most recently went to API in January 2024, it appeared he was seeking shelter from the winter cold. API staff brought Derius into the lobby and fed him but did not admit him. Derius then returned to API over the next couple of days, rambling to himself and shouting. During this time, he wore only a thin jacket despite it being winter, and he appeared to be intoxicated. API staff were aware that Derius had a history of methamphetamine use. Staff initially sent Derius away but admitted him after he returned several times.

B. Proceedings

1. 30-day commitment hearing

On January 31, 2024, API petitioned for a 30-day commitment and for approval to administer psychotropic medication. The petition alleged that Derius was presenting as “overtly psychotic with emotional dysregulation resulting in cyclical incarcerations and hospitalizations, rendering him unsafe to navigate community resources.” The 30-day commitment and medication hearings were held on February5, 2024. Both an API nurse practitioner and a court visitor testified. Derius waived his presence for the hearing.

The nurse testified that he had known and treated Derius on and off for close to five years and that Derius had suffered from schizoaffective disorder throughout that time. He said Derius consistently has “grandiose delusions” but his “emotional dysregulation, as in his irritability, mood lability, and speech patterns ... fluctuate.” When Derius was most recently admitted to API, the nurse could not meaningfully engage with him due to his “floridly psychotic” presentation and elevated agitation level. This differed from prior interactions when API staff had determined that “he was ... at his baseline functioning.” The nurse said that Derius told him that morning that he “wanted to go to the Holiday Inn or Econo Lodge and he needed 14 rooms to conduct his business,” despite the fact that Derius had been banned from most establishments in Anchorage.

Star page 2*2 Although the nurse noted no new medical diagnoses, he recommended against discharge into the community due to the cyclical nature of Derius's admittance to API and his increased mental deterioration over the past couple of years. The nurse recalled six admissions in 2022, five admissions in 2023, and two in 2024 as of February 5. He also said Derius required medication to stabilize his condition but did not want to take it. Although Derius had appointments scheduled with outpatient providers in the past, the nurse said he had never known Derius to show up to such appointments. And the nurse believed Derius's condition may improve with treatment, but he did not think Derius would take medication if he left API.

But the nurse had ideas for Derius's continuity of treatment outside API. Although Derius's family had not been involved in his treatment plan for some time, there was a new possibility of sending him to live with family in Arizona. Mentioning “no real further supports” in Alaska, the nurse characterized Derius's family's engagement with his treatment as an important and positive development and described feeling “very hopeful” about the Arizona plan.

Regarding API's medication petition, the nurse testified that his proposed medication plan was the same plan he recommended for Derius the last time he was treated at API, that the plan benefited Derius previously, and that the nurse had witnessed no side effects while previously implementing that plan. The plan included administration of multiple medications, including two antipsychotics and a mood stabilizer, among other medications.

Meanwhile, the court visitor testified that Derius was too disoriented to survive outside of a structured setting due to his long history of assault, aggressive behavior, refusal of services, “los[s] [of] services because of aggressive behavior,” “grandiose delusions,” “chronic cognitive impairment,” and TBI. She also noted a “history of medication noncompliance,” including since his last API visit. She recounted her conversation with Derius's brother, Aurthur, who wanted his brother to come live with him in Arizona. But overall, Aurthur and Derius's mother said they wanted Derius to remain at API until he was stabilized. The court visitor further testified that given the extent of Derius's delusions, he was “not currently competent to give or withhold informed consent.”

Following the hearing, the court granted the State's 30-day commitment and medication petitions.²

2. 90-day commitment hearing

In late February 2024, API filed a petition for 90-day commitment, asserting that Derius continued to be gravely disabled, “[r]emain[ed] unable to participate in treatment/discharge planning due to [the] extent of [his] delusional thought processes,” and “[w]ould be unable to manage within the community if released” from care. API also filed a petition to administer psychotropic medicine.

The superior court held a hearing on March 13, 2024. The court heard testimony from an API doctor, as well as from an API social worker, Derius's mother, and Aurthur. Derius was also present.

The doctor's testimony was based on both a review of Derius's records and in-person interactions. She testified that Derius was mentally ill and diagnosed with schizoaffective disorder bipolar type, TBI, and polysubstance dependence. She said Derius had gone over a month without requiring restraints, seclusions, or crisis medications, and had had only two aggressive “episodes” during his treatment at API, on February 2 and 10.

She described Derius's “angry” behavior during those incidents, “where he was threatening staff he was going to hurt [them], he was going to beat down one of the nurses. He pushed one of the environmental carts at [staff], started fighting with [them].” But she also noted Derius had not “acted out” since February 10, which was when he learned of his 30-day commitment. The doctor also confirmed that Derius was voluntarily taking his medication as of the day of the hearing. Although continued treatment would likely not improve Derius's TBI, it was reducing his aggression and could improve other symptoms associated with his psychosis and schizophrenia.

Star page 3*3 The doctor also discussed the potential Arizona discharge plan. She first testified that the flight to Arizona would be very challenging for Derius in his present condition. She then expressed discomfort with sending Derius to live with Aurthur, where it may be “a relaxed environment where he can come and go.” Since Aurthur had only attended one virtual meeting with API staff at that point, the doctor suggested scheduling follow-up meetings to fully brief Aurthur on Derius's condition.

Derius's mother then testified telephonically regarding her desire for Derius to remain in Alaska because nobody in Arizona knew him, making him more likely to encounter danger or end up incarcerated. She said Aurthur worked 12-hour shifts, and she expressed confusion over who would watch Derius. By contrast, she mentioned support he had in Anchorage and testified that local police knew him. She further indicated that Derius had said he did not want to go to Arizona. Derius confirmed his mother's understanding later in the hearing, when he said, “I don't know nothing about Arizona,” and “Arizona don't do nothing for me. What is that going to do for me, some place I don't even know. Why?” Finally, Derius's mother mentioned the need to better regulate Derius's medications, as he was “so heavily drugged” that “he [could] barely speak” when she called him at API.

Aurthur also testified telephonically. He said that he was offering his home to Derius, despite not having seen his brother for about 15 years. Aurthur confirmed he would follow API's medication guidance, though he also alluded to “mishaps” with Derius's medication and feeling uncomfortable with the dosage because he knew it made his brother feel sick. Aurthur also shared he had five young children living at home, including a baby. When asked how Aurthur would handle Derius's potential aggression, Aurthur simply said he would “deal with him.”

Derius interrupted throughout the hearing. In response to the doctor's testimony regarding the Arizona plan, Derius said, “I'm ready to discharge and everything.” But shortly after, he continued talking about people fighting over his money. And directly after the court described the purpose of the hearing — to understand if Derius would be fine staying at API until he was in the best physical and mental position possible to fly to Arizona — Derius again mentioned his various hotel rooms.

The court ordered Derius's 90-day commitment after making several findings. It found by clear and convincing evidence that, Derius was gravely disabled under AS 47.30.915(11)(A); he presented with delusions and paranoia, was incapable of rational discourse, and acted manic, angry, and threatening; there were no feasible less restrictive treatment options available because Derius had been “86[ed]” from other assisted living facilities and shelters in Anchorage; Derius's brother was willing to house and care for Derius in Arizona when Derius became more stable; Derius was not presently safe for air travel; and it was unclear what Derius's wishes were, other than to leave API.

Because Derius had been taking his medications at the time of this hearing, the court continued discussion of the State's medication petition to a later date.

3. Medication petition

On March 27, 2024, the superior court held a hearing on API's petition for administration of psychotropic medications. The court again heard testimony from the nurse and the court visitor. Derius was present at the hearing and again made several remarks throughout, both intelligible and unintelligible.

Star page 4*4 The proposed medication plan was the same as the one administered following Derius's 30-day commitment.³ The plan included the conjunctive administration of seven medications, including two antipsychotics and one mood stabilizer. The court visitor testified that as of March 14, Derius had been “selective or noncompliant” in taking his medications. Treatment team records indicated that “since stopping medication or being medication-selective, there ha[d] been a notable decline in [Derius's] thought organization and speech patterns.” API staff also reported Derius had been “increasingly paranoid and harder to redirect.”

The court visitor testified that when asked about his diagnoses, Derius said API repeatedly told him he did not have any mental health challenges and that he did not understand why he was at API. Derius asked to be discharged from the hospital so that he could return to his rooms at various hotels. He asked for the keys to those rooms and that the money in his account be transferred to him. Based on the court visitor's review of the records and conversations with Derius, Aurthur, and Derius's mother, the visitor testified that Derius was incompetent to give or withhold informed consent and unable to participate in treatment or discharge planning.

The nurse testified consistently with the court visitor's account, adding that while Derius provided “marginal ... insight” into his medication plan at times, that was atypical. He reiterated that there was no way Derius could benefit from non-medication-based therapy due to “the extent of his thought disorganization.”

The court found that there was insufficient evidence that Derius had previously expressed a clear wish regarding the administration of psychotropic medication. At the conclusion of the hearing, the court granted the petition for administration of involuntary medications.

Derius appeals.

III. STANDARD OF REVIEW

As a preliminary matter, the parties dispute the applicable standard of review and whether certain issues were preserved for appeal. Derius initially advocates for plain error review of his argument regarding API's failure to discuss the option for voluntary treatment, clear error review as to the availability and feasibility of a less restrictive alternative to commitment, and de novo review as to his capacity to provide informed consent. The State responds that because Derius failed to object to any of the master's findings in the 90-day commitment order and the involuntary medication order, plain error review applies to each of Derius's arguments. And the State contends that given Derius's failure to frame his arguments under the plain error standard in the first instance, he waived his arguments regarding less restrictive alternatives and capacity to provide informed consent.

“We review issues raised for the first time on appeal for plain error.”⁴ “A plain error involves an ‘obvious mistake’ that is ‘obviously prejudicial.’ ”⁵

Star page 5*5 Both the Alaska Civil Rules and Probate Rules control hearings on commitment and medication matters. Alaska Civil Rule 53(d)(2) states that “any party may serve written objections”⁶ within ten days of the master's report. But Alaska Probate Rule 2(f)(1) states that “[o]bjections to a master's report or recommendation must be filed within 10 days.”⁷

We fleshed out this apparent difference in In re Hospitalization of Carter K., where we noted that “[a]lthough the language of the probate rule is similar to that of the civil rule, the probate rule's language is stronger.”⁸ There, we cited precedent indicating that “may” in Civil Rule 53 required a timely objection to preserve a claim.⁹ Probate Rule 2(f)’s language is clearly mandatory: a party “must” file a timely objection to preserve a claim for appeal. Our precedent confirms that “issues not raised before the master are reviewed only for plain error.”¹⁰

Here, neither party objected to the master's recommended findings and conclusions, and the master's conclusions were adopted by the superior court. We therefore conclude that the plain error standard of review applies to all three issues raised on appeal.¹¹

IV. DISCUSSION

Derius challenges the superior court's 90-day commitment order on two bases. First, he argues that the court erred in granting the petition without investigating sua sponte whether API had discussed voluntary admission and treatment with Derius prior to committing him. Because the State presented conflicting evidence regarding whether Derius was advised of and had the opportunity to seek voluntary treatment prior to his admission, we conclude it was an obvious mistake for the court to issue the commitment order. Nevertheless, particularly where the record contains evidence that Derius did not want to stay at API, we conclude that the court's mistake was not prejudicial.

Second, Derius argues that the court erred in determining that there was no alternative less restrictive than civil commitment suitable to meet his treatment needs, especially in light of the possible plan for Derius to be discharged to Arizona to live with his brother. Because the record indicates that the State and the court considered alternatives to commitment and the record supports the court's determination that there were no alternatives appropriate to meet Derius's treatment needs, we conclude that the superior court did not plainly err, and we affirm the 90-day commitment order.

Derius also challenges the superior court's order for the involuntary administration of medication on two bases. First, he argues that the State did not meet its evidentiary burden because it presented conflicting evidence regarding his capacity to make medical decisions at the time of the medication hearing. But evidence in the record supports the court's conclusion that Derius was incapacitated at the time of the hearing. Second, Derius argues that the court was obliged to determine whether he had expressed a prior wish not to take medication in the future and whether he was competent when he previously expressed this wish. But because the relied-upon testimony regarding Derius's prior statements about his medications could not readily be understood in the way that Derius urges, we conclude the superior court did not plainly err and we affirm the medication order.

A. The Superior Court Did Not Plainly Err By Ordering Commitment.

1. The superior court made an obvious mistake.

Star page 6*6 When a treatment facility petitions for civil commitment, it must “allege that the respondent has been advised of the need for, but has not accepted, voluntary treatment.”¹² This statutory requirement safeguards against unnecessary involuntary commitment, affording patients the opportunity to voluntarily undergo treatment.

Derius argues that the testimony during his 90-day commitment hearing indicated that he had not been advised of the opportunity to voluntarily participate in treatment, and that although he did not object to the proceedings or the master's findings, we should hold that the superior court plainly erred by then proceeding with involuntary commitment. He further argues that API's statutory violation was an obvious mistake that amounts to a constitutional violation.

The State disagrees, arguing that the cited statutory requirements are distinct from the constitutional requirement that involuntary commitment be the least restrictive alternative. The State contends that the superior court made no obvious mistake in choosing not to inquire further into whether or not API actually discussed voluntary admission with Derius. It argues that AS 47.30.730(a) “merely dictates what information a commitment petition must allege” rather than prescribing “what findings a court must make.”

The record here is unclear on whether API advised Derius of the opportunity for voluntary admission and treatment, given the conflicting assertion in the petition and testimony of the API doctor. The petition alleges that Derius was “advised of the need for, but [had] not accepted, voluntary treatment” at API. But the doctor who testified in place of the nurse at the 90-day hearing indicated that she did not think anyone at API ever discussed voluntary admission and treatment with Derius. In light of this record, we conclude that it was an obvious error for the court to commit Derius without inquiring further into whether he had been informed of his ability to seek voluntary treatment.

2. The superior court's mistake was not obviously prejudicial.

Although we conclude that the superior court made an obvious mistake, an obvious mistake must also be obviously prejudicial for there to be plain error requiring reversal.¹³

Derius argues that we should conclude that the violation of AS 47.30.730 at issue was obviously prejudicial. Contending that the violation is a constitutional one, he cites our decision in Adams v. State to suggest that “[w]hen ... [an] error is constitutional in nature, the [S]tate bears the burden to prove the error is harmless beyond a reasonable doubt.” Derius cites no precedent, however, supporting application of this criminal standard to assertions of plain error in civil commitment matters. And we have consistently defined plain error as requiring an obvious mistake resulting in obvious prejudice in civil commitment matters, even where the asserted errors were constitutional in nature.¹⁴

The State responds that there cannot be obvious prejudice here because Derius does not assert that the outcome would have changed had API offered voluntary admission. It references the extensive testimony heard by the superior court regarding Derius's wish to leave API, both before and during the 90-day hearing. For example, Derius had “started fighting” with API staff, which resulted in him being restrained and secluded. And Derius's own counsel said Derius wanted to leave API. Without adequate reason to believe that Derius would have accepted voluntary treatment, the State contends there was no obvious prejudice.

Star page 7*7 We conclude that the court's mistake in not clarifying whether Derius had been advised of his ability to seek voluntary treatment was not obviously prejudicial.¹⁵ Derius never testified that he wished to voluntarily admit to API in the first instance or that he would have assented to admission and treatment if afforded the opportunity. On the contrary, statements on the record from both the doctor and Derius himself indicated that he likely would not have assented to voluntary treatment. For example, the doctor predicted in her testimony that “if [Derius] signs in voluntarily, the next day he's going to want to discharge.” Derius's statements at the hearing confirmed her belief; he repeatedly said, “[D]ischarge me and release me ...” and “I'm ready to discharge and everything.” Thus, Derius's ability to assent to voluntary treatment was not obviously prejudiced.¹⁶ Concluding that the court's mistake was not obviously prejudicial, we hold that the court did not plainly err in issuing the 90-day commitment order.

B. The Superior Court Did Not Plainly Err By Determining There Were No Less Restrictive Alternatives To Involuntary Commitment.

“An important principle of civil commitment in Alaska is to treat persons ‘in the least restrictive alternative environment consistent with their treatment needs.’ ”¹⁷ This idea is both a constitutionally and statutorily enshrined requirement. We have held that a finding of no less restrictive alternative “is a constitutional prerequisite to involuntary hospitalization,”¹⁸ explaining that “the [superior] court's deliberate consideration of [whether less restrictive alternatives exist] is critical to the protection of the respondent's liberty interests.”¹⁹ The superior court is also statutorily required to consider whether a viable less restrictive alternative to commitment exists before issuing an involuntary commitment order.²⁰ The State “is not required to prove the unavailability of every imaginable alternative.”²¹ But as the “party with the knowledge and resources to meaningfully consider alternatives,” the State carries the burden of showing that it had engaged in such deliberation.²² And this is a “substantial burden.”²³

The legislature defines the “least restrictive alternative” as mental health treatment facilities and conditions of treatment that

(A) are no more harsh, hazardous, or intrusive than necessary to achieve the treatment objectives of the patient; and

(B) involve no restrictions on physical movement nor supervised residence or inpatient care except as reasonably necessary for the administration of treatment or the protection of the patient or others from physical injury.^[24]

To be viable, an alternative must be “feasible, available, and provide adequate treatment for a respondent.”²⁵ And here, because Derius did not challenge the master's findings in writing or orally, the issue is reviewed for plain error.²⁶

Star page 8*8 Derius disputes the court's findings related to the adequacy and feasibility of less restrictive alternatives to commitment, particularly the plan to discharge Derius from API and move him to Arizona to live with his brother. His primary argument on appeal appears to be that API failed to prove the Arizona discharge plan was unavailable or would not adequately meet his needs. But there was evidence before the court that Derius either did not want to move to Arizona or did not understand the Arizona plan. During the 90-day commitment hearing, Derius asserted his unwillingness to move, stating, “I don't know nothing about Arizona,” and “Arizona don't do nothing for me.” Aurthur also acknowledged that “Alaska is all [Derius] knows” and was alternatively willing to make provisions here.

Moreover, multiple people testified regarding their concerns about Derius's travel to Arizona and potential issues once there. The doctor doubted that Derius could safely travel via a commercial airline. And she said that Aurthur's home would present “too relaxed of a[n] environment” where Derius would be able to “come and go ... roam the neighborhood, get into assaultive behaviors, [and] maybe even end up in Department of Corrections.” His mother also testified that the Arizona plan was “not going to work out, period.” She pointed out that Aurthur “works 12-hour shifts” and therefore would not be home to watch Derius. And Aurthur shared no concrete plan for how he would handle Derius's potential aggression, despite the presence of small children in the house.

The State argues that it met its burden of proving that there were no less restrictive alternatives to civil commitment, including the Arizona plan. An API social worker testified that Derius had been “86[ed]” from assisted living facilities and shelters in town. And the doctor testified that “the residential facilities [in Anchorage] are not very willing to take him because of his assault history.” In the past, his mother had had to call the police due to his violent behavior. Derius's delusions compounded the difficulties of any potential discharge plan. And as discussed by the doctor, the State considered sending Derius to live with his brother, Aurthur, in Arizona, but concluded that that plan was not a viable one at that time.

Given the record here, we see no error, plain or otherwise, in the superior court's findings and order regarding the lack of less restrictive alternatives. In light of that evidence and Derius's own statements, the superior court concluded that although discharge to Arizona could be adequate and feasible at a later date, it was not at that time. Moreover, we reject Derius's likening of this case to In re Hospitalization of Declan P.²⁷ There, Declan proposed a less restrictive alternative that involved returning home, taking his medication, working with his outpatient provider, and having his neighbor monitor his medication compliance multiple times daily.²⁸ Derius argues that both Declan's plan and the Arizona plan were better than most because, like Declan, Derius's symptoms had improved and he had someone willing to care for him to ensure he received necessary mental health services.²⁹ There are significant differences, however, between the situation at issue here and that in Declan P. First, prior to the hospitalization at issue in Declan P., Declan maintained stability with outpatient treatment, including by consistently taking his prescribed medications, and successfully lived independently.³⁰ Those important facts are in stark contrast with the testimony here regarding Derius's history and his present inability to meet his basic needs or to engage in an outpatient treatment plan. Additionally, whereas Declan endorsed the plan for him to return home and remain engaged with outpatient treatment,³¹ and indeed, had a long history of success in those settings, Derius expressed strong disagreement with the proposed plan to have him travel to Arizona.

Star page 9*9 Unlike in cases where “the State did not discuss or explore any treatment alternatives beyond the one outpatient treatment plan Declan proposed,”³² the State met its burden here by demonstrating why other options were “infeasible and inadequate to protect the respondent and the public, and provide for the respondent's treatment needs.”³³ Therefore, the superior court made no obvious mistake in determining that there were no less restrictive alternatives to commitment.

C. The Superior Court Did Not Plainly Err By Ordering The Involuntary Administration Of Psychotropic Medication.

1. Derius lacked capacity to make medical decisions at the time of the hearing.

A court may order involuntary administration of psychotropic medication only if it finds, “by clear and convincing evidence, that the patient is not competent to provide informed consent and was not competent to provide informed consent at the time of previously expressed wishes.”³⁴

“Competent” in this context means the patient

(A) has the capacity to assimilate relevant facts and to appreciate and understand the patient's situation with regard to those facts ... ;

(B) appreciates that the patient has a mental disorder or impairment, if the evidence so indicates; denial of a significantly disabling disorder or impairment, when faced with substantial evidence of its existence, constitutes evidence that the patient lacks the capability to make mental health treatment decisions;

(C) has the capacity to participate in treatment decisions by means of a rational thought process; and

(D) is able to articulate reasonable objections to using the offered medication.^[35]

A patient must satisfy all of these elements to be deemed competent to provide or withhold informed consent.³⁶

Additionally, AS 47.30.837(c) provides the standard for determining a patient's capacity to provide informed consent. A patient can refuse medication unless the State shows, by clear and convincing evidence, that “the patient cannot demonstrate the capacity to understand the patient's situation and assimilate relevant facts, is unable to participate in treatment decisions, or is unable to articulate any objections to the proposed medication.”³⁷ If, however, a competent person expresses a wish to refuse treatment, the court cannot override that desire, even if the person becomes incompetent.³⁸

Derius argues that the court erred by granting the medication petition because it ignored potential inconsistencies in the testimony regarding his capacity to consent to treatment. In particular, Derius points out that the nurse testified that Derius had been unable to appreciate his need for medications since he had arrived at API, which would have prohibited API from medicating Derius, without a medication order or advanced directive,³⁹ during noncrisis situations. But the nurse also indicated that API had been treating Derius with medications on a voluntary basis, and that Derius had been able to participate in some treatment team meetings, indicating some limited capacity to consent to treatment, and that API had filed the medication petition due to Derius's recent deterioration. Derius contends that this meant “API considered Derius to be competent at times during his hospitalization, undermining [the nurse]’s testimony that Derius had not been competent since his arrival at API.” On this record, Derius asserts that the court erred when it found he was unable to give or withhold informed consent at the time of the hearing, warranting vacatur of the medication order.

Star page 10*10 The State claims that the superior court did not make an obvious mistake when it found, based on the master's findings, that Derius was incompetent and thus lacked capacity to consent to treatment. The State argues that the evidence supported the court's findings that Derius “could not effectively assimilate facts regarding medication,” that “API's efforts to involve Derius in medication-related decisions were consistently unsuccessful,” and that Derius “was fixated instead on leaving API.”⁴⁰

Although we acknowledge the inconsistency in the nurse's testimony, we agree with the State that there was ample evidence in the record supporting the court's finding that Derius lacked capacity to consent to medications at the time of the hearing.⁴¹ For example, the court visitor testified that since Derius's most recent API admission, he had been “unable to participate meaningfully in treatment and discharge planning.” The nurse testified that Derius had been unable to “assimilate any relevant facts of taking medications at all,” and that “without the consistent medications, he[ ] [had] just drastically deteriorated.” Derius's own delusional and disorganized statements further confirmed the court visitor's and the nurse's testimony. And the court's order on record described Derius's “persevera[tion] on unrelated issues when staff and providers tr[ied] to involve him in the decision-making process with regard to his medical needs,” his focus “on getting out of API in kind of a nonlogical, nonlinear way,” and his inability to process information necessary to give consent. We see no plain error in the court's finding that Derius lacked capacity to provide or withhold informed consent to medications at the time of the hearing.

2. Derius was not competent to provide informed consent at the time of his previously expressed desire.

In addition to arguing that the court erred in determining that Derius lacked capacity at the time of the hearing, Derius contends that the court was not entitled to authorize the involuntary administration of medications because testimony reflected that he had previously expressed that he did not want to take psychotropic medications. In particular, the court visitor indicated during her testimony that in prior years Derius had told his brother Aurthur that he did not like taking psychotropic medications because they made him feel sedated. In light of this testimony by the court visitor, Derius argues that the court “should have determined whether [he had been] expressing his wish not to take medication in the future and whether he was competent when he previously expressed this.” Because the statute burdens the State to prove by clear and convincing evidence the absence of previously expressed desires,⁴² Derius contends the court failed to hold the State to its burden and improperly shifted the burden to him.

The State responds that the court did not make an obvious mistake in determining that Derius had not previously, while competent, refused future psychotropic medication. It contends that the court visitor's investigation did not demonstrate that Derius articulated a desire to refuse future medication. Rather, the State asserts that patients are “often dissatisfied with their medications’ side effects.” Moreover, the State characterizes the conversation between Derius and Aurthur as a “broader dialogue about the pros and cons of medication, rather than a definitive declaration that Derius refused all future medication.”

Star page 11*11 Nonconsensual psychotropic treatment implicates “fundamental liberty and privacy interests.”⁴³ And the court may not approve involuntary medications in a noncrisis situation where a person has previously, while capable of providing or withholding informed consent, expressed a desire not to consent to medications.⁴⁴ But here, the testimony that Derius focuses upon does not readily reflect that his statements to his brother rose to the level of expressing a desire to forego any future psychotropic medication. Rather, the court visitor's investigation revealed that Derius had complained about the symptoms associated with medication that he was consenting to at the time. Although there may have been some confusion regarding the nature of Derius's statements and his mental clarity when he made those statements, the court's determination that Derius had not previously, while competent, refused psychotropic medication as a general matter was not obviously mistaken. We therefore see no plain error.

V. CONCLUSION

We AFFIRM the superior court's orders on commitment and administration of involuntary medications.

Footnotes

1

Pseudonyms have been used to protect the party's privacy.

2

Derius does not challenge the court's 30-day commitment order on appeal.

3

The medication plan included two forms of the same medication, one of which was administered daily and another of which was administered every 28 days. The nurse testified that it was Derius's refusal of the form administered every 28 days that prompted the petition, because the nurse believed that administering “that consistent medication every 28 days ... [would allow for] more of a steady-state therapy.” He also confirmed that the plan was not outside the medical standard of care, either in dosage or purpose of the medication, despite the high dosage and simultaneous administration of multiple medications.

4

In re Hospitalization of Carter K., 557 P.3d 755, 761 (Alaska 2024) (quoting In re Hospitalization of Connor J., 440 P.3d 159, 163 (Alaska 2019)).

5

Id. (quoting In re Hospitalization of Tonja P., 524 P.3d 795, 800 (Alaska 2023)).

6

Alaska R. Civ. P. 53(d)(2) (emphasis added).

7

Alaska R. Prob. P. 2(f)(1) (emphasis added).

8

557 P.3d at 761-62.

9

Id. (citing Duffus v. Duffus, 72 P.3d 313, 318-19 (Alaska 2003)).

10

See id. at 762 & n.21.

11

Because Derius made arguments in his original briefing regarding the substantive points at issue, and because the State briefed the arguments under the plain error standard and thus was not prejudiced, we reach the issues and decide them under the plain error standard. We observe, however, that Derius's failure to acknowledge the plain error standard of review in his opening briefing prevented him from later pursuing new arguments related to that standard.

12

AS 47.30.730(a)(5) (30-day commitment requirement); AS 47.30.740(a) (incorporating 30-day commitment requirement into 90-day commitment requirement).

13

In re Hospitalization of Tonja P., 524 P.3d 795, 800 (Alaska 2023).

14

See e.g., In re Hospitalization of Connor J., 440 P.3d 159, 163 (Alaska 2019); In re Carter K., 557 P.3d at 761-62.

15

See In re Carter K., 557 P.3d at 761.

16

See id.; see also In re Connor J., 440 P.3d at 165 (holding superior court's failure to make finding regarding waiver of presence at hearing was not obviously prejudicial because controlling statute did not require it).

17

In re Hospitalization of Joan K., 273 P.3d 594, 601 (Alaska 2012) (quoting AS 47.30.655(2)).

18

In re Hospitalization of Sergio F., 529 P.3d 74, 78 (Alaska 2023) (quoting In re Hospitalization of Naomi B., 435 P.3d 918, 933 (Alaska 2019)).

19

Id. (second alteration in original) (quoting In re Hospitalization of Mark V., 375 P.3d 51, 58 (Alaska 2016)) (internal quotation marks omitted).

20

AS 47.30.730(a)(2) (30-day commitment requirement); AS 47.30.740(a) (incorporating 30-day commitment requirement into 90-day commitment requirement); see also AS 47.30.655(2) (explaining idea “that persons be treated in the least restrictive alternative environment consistent with their treatment needs” was one principle of modern mental health care guiding 1981 revision of Alaska's civil commitment statutes).

21

In re Hospitalization of Vern H., 486 P.3d 1123, 1131 n.31 (Alaska 2021).

22

In re Hospitalization of Declan P., 538 P.3d 318, 325 (Alaska 2023).

23

Id. at 326 (quoting In re Hospitalization of Sergio F., 529 P.3d 74, 80 (Alaska 2023)).

24

AS 47.30.915(14).

25

See In re Hospitalization of Connor J., 440 P.3d 159, 163 (Alaska 2019).

26

In re Hospitalization of Carter K., 557 P.3d 755, 762 (Alaska 2024).

27

538 P.3d 318.

28

Id. at 324-25.

29

Id. at 323, 325.

30

Id. at 320.

31

Id. at 321, 323-25.

32

Id. at 325 (emphasis in original).

33

Id. at 326.

34

AS 47.30.839(g).

35

AS 47.30.837(d)(1); see also In re Hospitalization of Jacob S., 384 P.3d 758, 770 (Alaska 2016).

36

In re Jacob S., 384 P.3d at 771-72.

37

Myers v. Alaska Psychiatric Inst., 138 P.3d 238, 243 (Alaska 2006).

38

AS 47.30.839(d)-(g); Bigley v. Alaska Psychiatric Inst., 208 P.3d 168, 179-80 (Alaska 2009).

39

See AS 47.30.836.

40

The State links these assertions to the competency factors in AS 47.30.837(d)(1)(A) and (C), which discuss “capacity to assimilate relevant facts” and “capacity to participate in treatment decisions,” respectively, explaining that because Derius “could not effectively assimilate facts regarding medication” and “API's efforts to involve Derius in medication-related decisions were consistently unsuccessful,” the trial court did not make an obvious mistake when it found that Derius lacked capacity to consent to treatment.” AS 47.30.837(d)(1)(A), (C).

41

See AS 47.30.837(d)(1).

42

AS 47.30.839(g).

43

Myers, 138 P.3d at 246.

44

AS 47.30.839(d)-(g).

End of Document