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FOURTH JUDICIAL DISTRICT
DISTRICT COURT
COUNTY OF HENNEPIN
PROBATE/MENTAL HEALTH DIVISION
In the Matter of the Civil Commitment of: File No: P8-02-60415
FINDINGS OF FACT, CONCLUSIONS OF LAW AND ORDER AUTHORIZING ELECTROCONVULSIVE THERAPY
Respondent DOB: XX-XX-54
This matter was heard by Patricia L. Belois, one of the Judges of this Court, on September 12, 2002, pursuant to a Petition for Authorization to impose Treatment Electroconvulsive Therapy, filed herein on August 20, 2002.
Petitioner, Michael Popkin, M.D., was represented by Elizabeth Cutter, Assistant Hennepin County Attorney, A-2000, Hennepin County Government Center, Minneapolis, MN 55487, (612) 348-6740.
Ruth Y. Ostrom, Attorney at Law, 301 Fourth Avenue South, Suite 270, Minneapolis, MN 55415, 612-339-1453, was present on behalf of Respondent, who was present in court. Barabara Jackson, M.D., the Court-appointed examiner, and Derrinda Mitchell, Respondent's Court appointed Conservator of Person and Estate were present. No guardian ad litem was appointed for Respondent because her Conservator provides that function pursuant to an existing Court order from another jurisdiction.
Based upon the file and record in this matter, the evidence received, including testimony from Charles Pearson, M.D., Derrinda Mitchell, and Barbara Jackson, M.D. and one exhibit, the court makes the makes the following:
FINDINGS OF FACT 1. Respondent is 48 years old. She was committed dually to the Heads of the Hennepin County Medical Center and the Anoka Metro Regional Treatment Center as a person who is mentally ill by Order of this Court filed September 6, 2002. In that Order, the Court found that Respondent was mentally ill with Paranoid Schizophrenia. Respondent's present diagnosis is Paranoid Schizophrenia and Depression, NOS. Her treating physician has also diagnosed Respondent with Anxiety Disorder, NOS. Respondent is currently hospitalized at the Hennepin County Medical Center. 2. The Medical Director of Inpatient Psychiatry/Chief of Psychiatry for the Hennepin County Medical Center, Michael Popkin, M.D. (hereinafter Popkin) has petitioned the Court for authority to administer up to 15 treatments of electroconvulsive therapy (ECT) per week for a period of up to five weeks to Respondent, followed by maintenance treatments at an unspecified frequency for the duration of the current commitment. Testimony in support of this Petitioner's Petition was given by Respondent's treating physician, Charles Pearson, M.D. Petitioner believes that ECT will relieve the symptoms of Respondent's mental illness and provide other benefit to her, in particular, ECT is expected to: resolve Respondent's psychosis which is refractory to treatment with neuroleptic medication; improve Respondent's social withdrawal; and lead to simplification of her medication regime by reducing the number of neuroleptic medications she will need to take to control her symptoms.
3. Krishna Mylavarapu, M.D.,(herein after Mylavarapu), is the staff psychiatrist at the Hennepin County Medical Center who will administer the ECT to Respondent. Respondent will be anesthetized prior to the administration of the ECT. The only pain Respondent should experience from the ECT would be the minimal pain from the injection of the anesthetic and perhaps a transitory headache. There is a very remote risk of an adverse reaction to the anesthetic in the range of 1:20.000-50,000. Respondent may experience a short-tern memory loss as a consequence of the proposed treatment This memory loss may be permanent, but the effects of it can be fully mitigated by relearning the lost information, such as what she had to eat during the meal before the procedure. ECT does not involve surgical intrusion. The intrusion comes from electrical impulse directed into Respondent. s brain to induce a specific type of seizure activity.
4. The use of ECT during inpatient hospitalization is the best treatment, according to contemporary professional standards, that could render further custody, institutionalization or other services to the Respondent unnecessary. ECT is not an experimental treatment. It has not been prescribed for Respondent as part of any research project. Its use is widely accepted by the medical community of this state.
5. The Court's examiner, Barbara Jackson, M.D. (hereinafter Jackson), believes that the use of ECT to treat Respondent's mental illness is both necessary and reasonable. She testified that the benefits Respondent is likely to experience from ECT outweigh its risks to her. Jackson also testified that Respondent is not competent to weigh the benefits and risks associated with ECT treatment for herself.
5. Respondent's Conservator, Derrinda Mitchell, testified that she believes that the benefits of the proposed treatment, most particularly the possibility that Respondent's medication regime could be simplified and the exposure to medication side effects better controlled that way, outweigh the risks involved and that the use of ECT to treat Respondent's mental illness and that the use of ECT could be in Respondent's best interests.
6. The Court has considered less intrusive methods of treatment for Respondent's illness including the use of various psychotropic medications both alone and as part of augmented pharmacological regimen. This was rejected because the use of psychotropic medications to treat Respondent to date has not sufficiently relieved the symptoms of Respondent's mental illness so that she can be released from the acute care facility safely to which she is now committed.
7. Respondent cannot rationally weigh the risks and benefits involved in the use of ECT to treat her mental illness because she does not believe that she is mentally ill and she has an irrational fear of ECT fueled by information that her mother provides to her about what the mother believes is the lethal nature of ECT.
CONCLUSIONS OF LAW 1. The evidence is clear and convinces the Court that treatment of the Respondent's mental illness using electroconvulsive therapy is necessary and reasonable. 2. Respondent does not have the capacity to give or withhold consent to the use of electroconvulsive therapy to treat her mental illness. 3. The benefits to Respondent from the administration of electroconvulsive therapy to treat her mental illness outweigh the risks associated with the treatment and justify the intrusion into her privacy as needed to conduct the electroconvulsive therapy without Respondent's informed consent.
ORDER The Heads of the Hennepin County Medical Center and the Anoka Metro Regional Treatment Center are authorized to administer to Respondent up to 15 treatments of electroconvulsive therapy per week for up to five weeks, foIIowed by maintenance treatments as often as once per week for the duration of the commitment ordered September 6, 2002, pursuant to Price v. Sheppard. 239 NW2d 905 (Minn, 1976) and Minn. Stat ß253B,03, Subd. 6b.
BY THE COURT: Patricia L. Belois Date Judge of District Court Probate/lMental Health Division 9/16/02