The opinion
IN THE SUPREME COURT OF THE STATE OF DELAWARE
LAURA BROWN,1 §
§
Respondent Below, § No. 385, 2018
Appellant, §
§ Court Below—Superior Court
v. § of the State of Delaware
§
STATE OF DELAWARE, § C.A. No. 18I-01286
§
Petitioner Below, §
Appellee. §
Submitted: December 14, 2018
Decided: December 17, 2018
Before STRINE, Chief Justice; VALIHURA and TRAYNOR, Justices
ORDER
After consideration of the appellant’s opening brief, the State’s answering
brief, and the record below, it appears to the Court that:
(1) The appellant, Laura Brown, has a history of mental health issues. On
April 19, 2018, a Dover police officer completed a request for a twenty-four-hour
emergency detention of Brown under 16 Del. C. § 5004. The officer reported that
Brown had been in a Target store “for over 2 hours, talking to herself and screaming.
She stated that everyone is out to get her and wants to kill her. She has been
combative with officers and nursing staff. Her action put her and others at risk.” A
1
The Court has assigned a pseudonym to the appellant.
mental health screener evaluated Brown and observed that she was depressed,
manic, very angry, delusional, paranoid, and experiencing auditory and visual
hallucinations. The screener concluded that Brown’s altered mental status placed
her at a high risk of harm to self or others, and that she needed further psychiatric
evaluation.
(2) Following her twenty-four-hour emergency detention, Brown was
provisionally admitted to Dover Behavioral Health System Hospital. Dr. Khaled
Mirza completed a certificate for provisional hospitalization. The certificate stated
that Brown was diagnosed with “schizoaffective disorder, bipolar type, most recent
episode manic.” It concluded that Brown was a danger to herself and others because,
among other things, she was manic, psychotic, paranoid, and delusional; thought that
people were out to get her; and stated that she would defend herself. Dr. Mirza also
completed affidavits in support of involuntary inpatient commitment and
involuntary outpatient treatment, each of which made similar observations and
conclusions.
(3) On April 25, 2018, the State filed a complaint seeking involuntary
inpatient commitment and involuntary outpatient treatment, relying in part on the
psychiatrist’s affidavits. After an April 27, 2018 probable cause hearing and later a
May 4, 2018 “8-day hearing,” a Superior Court Commissioner ordered Brown’s
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continued involuntary inpatient commitment and involuntary outpatient treatment.
Brown’s next hearing was scheduled for July 20, 2018.
(4) On May 16, 2018, Brown was discharged from involuntary inpatient
treatment to begin involuntary outpatient treatment.
(5) On May 21, 2018, a Dover police officer completed another request for
a twenty-four-hour emergency detention of Brown. The officer reported that Brown
had refused to leave a store and was making statements that did not make sense. A
mental health screener evaluated Brown and observed that she was severely
delusional and paranoid, extremely aggressive, and disoriented; had attempted to
strike a nurse; and had stated, “I feel like killing someone.”
(6) On May 24, 2018, Dr. Nadeem Afzal completed a certificate for
provisional hospitalization, and on May 25, 2018, Dr. Afzal completed affidavits in
support of involuntary inpatient commitment and involuntary outpatient treatment.
These documents reflect Dr. Afzal’s conclusions that Brown was “very psychotic
and very manic,” paranoid, “hostile, aggressive and even threatening,” with
“impaired insight and judgment.” Dr. Afzal further stated that Brown had been
noncompliant with medication and that without medication “her state deteriorates,”
“she is unlikely to survive in the community,” and she posed a threat to herself and
others.
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(7) On May 29, 2018, the State filed a complaint seeking involuntary
inpatient commitment and involuntary outpatient treatment, relying on the police
officer’s 24-hour detention form and the psychiatrist’s affidavits, among other
things. After a May 29, 2018 probable cause hearing and later a June 6, 2018 “8-
day hearing,” a Superior Court Commissioner ordered Brown’s continued
involuntary inpatient commitment and involuntary outpatient treatment. Brown’s
next hearing was scheduled for August 29, 2018.
(8) On June 12, 2018, Brown was again discharged from involuntary
inpatient treatment to begin involuntary outpatient treatment.
(9) On June 26, 2018, Brown requested that the Superior Court hold a
hearing sooner than her then-scheduled August hearing, because she did not want to
continue the injectable medications that she was receiving as part of her involuntary
outpatient treatment. The Superior Court granted the request, scheduling a hearing
for July 20, 2018. Dr. Capiro testified at the July 20 hearing regarding Brown’s
history and diagnoses and her noncompliance with oral medications. He testified
that Brown needed to stay on injectable medications and that outpatient commitment
was the least restrictive alternative for Brown to receive the needed treatment. At
that hearing, Brown told the Commissioner about the negative effects that the
injections had on her, including a “creepy crawly feeling all over me” and a zombie-
like feeling, and requested that the Court permit her to stop receiving the injections.
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At the conclusion of the hearing, the Commissioner ordered that the involuntary
outpatient treatment would continue.
(10) Brown appealed the Commissioner’s order, and on August 7, 2018 a
judge of the Superior Court affirmed. Brown now appeals to this Court.
(11) The Commissioner’s July 20, 2018 order consists of one-half of a page
of notes about Dr. Capiro’s testimony and a check-the-box form with preprinted
legal conclusions and authorization for involuntary treatment. The Superior Court
summarily affirmed the Commissioner’s order. Although these are not the ideal
circumstances for this Court’s review of the Superior Court’s findings of fact and
conclusions of law, it appears from the order and the record as a whole that the
Commissioner’s factual findings were sufficiently supported by the evidence and
that the legal requirements for Brown’s involuntary treatment were satisfied.2
(12) The involuntary commitment statute provides:
A person shall be involuntarily committed by the court for outpatient
treatment over objection only if all of the following criteria are satisfied
by clear and convincing evidence:
(1) The person is 18 years of age or older.
(2) The person has a documented mental condition.
(3) The person is reasonably expected to become dangerous to self
or dangerous to others or otherwise unlikely to survive safely in
the community without treatment for the person’s mental
condition.
2
Cf. Jamison v. Division of Family Servs., 2011 WL 257810, at *3 (Del. Mar. 8, 2001) (discussing
the standard of review applicable to an appeal from an order terminating parental rights, which
requires a clear and convincing standard of proof).
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(4) The person is currently refusing to voluntarily participate in the
treatment plan recommended by the person’s mental health
treatment provider or lacks the capacity to determine whether
such treatment is necessary.
(5) The person has a documented history of lack of adherence with
recommended treatment for the mental condition, or poses an
extreme threat of danger to self or danger to others based upon
recent actions, that has either:
a. Resulted in a deterioration of functioning that was observed
to be dangerous to the individual’s personal health and safety;
or
b. Resulted in a deterioration of functioning that was observed
to be imminently dangerous to self or dangerous to others,
including but not limited to suicidal ideation, violent threats,
or violence towards others.
(6) All less restrictive treatment options have been considered and
have either been determined to be clinically inappropriate at this
time or evidence is offered to show that the person is not likely
to adhere to such options.3
(13) The Court concludes that each of the statutory requirements is
sufficiently supported by the record. First, Brown is over 18 years of age. Second,
at the July 20, 2018 hearing, Dr. Capiro testified regarding Brown’s diagnosed
mental conditions, including paranoid personality disorder and schizoaffective
disorder, bipolar type. Third, Dr. Capiro testified that Brown was reasonably
expected to become dangerous to herself or others without treatment; he specifically
cited her history of walking into traffic and overdosing on medications. Fourth, Dr.
Capiro testified that Brown refused to voluntarily take injectable medications, which
3
16 Del. C. § 5013(a).
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was the only effective means to treat her under the circumstances. Fifth, Dr. Capiro
testified that he had tried to treat her with oral medications, but Brown had been
either noncompliant or had not taken the correct doses; he further testified that
following Brown’s prior commitments, she had stopped treatment and her condition
had deteriorated, and that there was no likelihood of voluntary compliance. Finally,
Dr. Capiro testified that involuntary outpatient treatment was the least restrictive
option, given Brown’s history and past noncompliance with other treatments. The
record also reflects that Dr. Capiro’s testimony was consistent with the findings of
two other psychiatrists who evaluated Brown just a few months earlier and also
recommended her involuntary commitment.
NOW, THEREFORE, IT IS ORDERED that the judgment of the Superior
Court is AFFIRMED.
BY THE COURT:
/s/ Karen L. Valihura
Justice
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