Appeal from Superior Court, Washington Unit, Family Division.
Marilyn Skoglund, J., Specially Assigned William H. Sorrell,
Attorney General, Montpelier, and Philip Back, Assistant
Attorney General, Waterbury, for Petitioner-Appellee.
Rebecca T. Plummer, Vermont Legal Aid, Inc., Montpelier, for
PRESENT: Reiber, C.J., Dooley, Robinson and Eaton, JJ., and
Hoar, Supr. J., Specially Assigned.
1.In this case, an involuntarily hospitalized patient
diagnosed with schizophrenia appeals the trial court's
order allowing for his involuntary medication. Patient argues
that the court erred by (1) incorrectly applying the
competency standard under 18 V.S.A. § 7625, and (2)
failing to address whether a previously prepared document
reflecting his desire not to be given psychiatric medication
was a "competently expressed written . . . preference
regarding medication" under 18 V.S.A. § 7627(b). We
conclude that the trial court's findings support its
conclusion under § 7625, but agree that the trial court
did not squarely address patient's argument under §
7627 in its findings. Accordingly, we reverse on that issue
and remand for the trial court to issue findings addressing
the applicability of §7627(b) to patient's prior
written expression of his preferences.
2. Patient is thirty-two years old and is from Morrisville.
He was hospitalized at the Vermont Psychiatric Care Hospital
(VPCH) in Berlin on April 15, 2016, pursuant to a court order
stemming from his arrest and criminal prosecution for
allegedly assaulting his girlfriend. Patient had been
hospitalized once before-also at VPCH-from May 5, 2015, to
July 28, 2015. During that previous hospitalization, patient
was diagnosed with schizophrenia and-in July 2015- VPCH
unsuccessfully sought a court order to involuntarily medicate
3. In the present case, the court noted that it rejected the
State's prior request to involuntarily medicate patient
because the State did not prove that he was incompetent and
the potential side effects of the medication outweighed its
potential benefits. Shortly after the court in the previous
case decided not to involuntarily medicate him, patient was
discharged from VPCH and began living at Soteria House, a
residence for people with mental illness in Burlington.
4. While there, patient signed a document purporting to be an
advance directive in which he stated that he did not want any
psychiatric medication because such medication caused him
anger and homicidal ideation and inhibits "the limbic
system from powering organs." By a checkbox on the form,
he indicated that he was aware that his stated preference
might result in longer hospital stays and may result in his
being involuntarily committed or treated, and he prioritized
the interventions he prefers by listing seclusion, then
seclusion and physical restraints combined, then physical
restraints first, with medication in pill, liquid, and
injection form as his lowest priorities. Patient concedes
that this document "did not meet the statutory
requirements of an advance directive because it was not
signed by two witnesses."
5. Following his current hospitalization, the State filed an
application to involuntarily medicate patient over a
ninety-day period on April 21, 2016. A hearing was held on
May 4, 2016, at which the State presented one
witness-patient's treating psychiatrist-and patient
presented two witnesses-himself and a staff person from
6. First, patient's psychiatrist testified that he had
treated patient during both his previous hospitalization and
his current hospitalization. The psychiatrist described a
pattern of beliefs and behaviors starting in 2012 that led
him to diagnose patient with schizophrenia:
[Patient] has shown fixed false beliefs . . . he's shown
evidence of acting on persecutory delusions in a manner that
seems dangerous at certain points. He also shows disorganized
thought process. His speech wanders from topic to topic.
He also shows unusual behaviors around clothing and,
let's say- taking apart the seams in his clothing to
replace the threads with organic material because of a
preoccupation with toxins.
. . .
[H]e thinks medications are also toxic. ...