Procedural Protections in Civil Commitment Proceedings

Facts of the Case

M.A.C. was placed under a mental health commitment with an order for involuntary medication in Waukesha County in 2020. Under this commitment, M.A.C. was being treated as an outpatient and taking three medications, one of which was an injection. The commitment was extended twice between 2020 and 2022. During 2022, M.A.C. was homeless and missed multiple psychiatric appointments, including for administration of her injectable medication.

On July 19, 2022, as the commitment again approached expiration, Waukesha County petitioned the Waukesha County Circuit Court to extend both M.A.C.’s commitment and the order for involuntary medication. Multiple notices of the hearing were sent to M.A.C.’s attorney and her case manager. Notice was also to be sent to M.A.C., but M.A.C.’s address was listed as “homeless,” and the notice was never delivered to her. M.A.C.’s attorney and her case manager attempted to find M.A.C. but were unable to locate her prior to the recommitment hearing.

The notice also included directions for M.A.C. to contact two physicians for a court-appointed examination to evaluate her fitness for recommitment and whether she needed involuntary medication. The physician examiners were advised that M.A.C. “was currently located at ‘Homeless, please send documents to her Case Manager’” (M.A.C., p 368). Neither physician was able to speak to M.A.C. before completing their reports so were unable to explain to her the advantages, disadvantages, and alternatives of taking psychotropic medications. Nonetheless, both examiners opined that M.A.C. was “incapable of applying an understanding of the advantages, disadvantages and alternatives to make an informed choice as to whether to accept or refuse psychotropic medication” (M.A.C., p 369). In coming to an opinion, one examiner reviewed M.A.C.’s treatment records and court documents and spoke with her case manager, whereas the other did not indicate what records he reviewed.

In August 2022, M.A.C. did not appear at the recommitment hearing. M.A.C.’s attorney did not know how M.A.C. would like to proceed. Waukesha County asked the court to enter default judgment to extend M.A.C.’s commitment and medication order, noting that the alternative would be to detain M.A.C. for another hearing. Such a detention would require M.A.C. to return to a carceral or inpatient setting, which the county did not feel was in M.A.C.’s best interests or the least restrictive setting required for her care. The county also had identified three proposed witnesses to testify but did not call them. Instead, they asked the court to rely on the physician expert reports to extend M.A.C.’s commitment and involuntary medication order. The court agreed with the county and ordered a 12-month extension of M.A.C.’s commitment and involuntary medication order.

M.A.C. appealed this decision, arguing that notice should have been delivered to her and not just to her attorney and case manager, that default judgment should not have been an available option in a recommitment hearing, and that insufficient evidence was given to justify the court’s extension of her involuntary medication order. The Wisconsin Court of Appeals affirmed the circuit court’s decision, and M.A.C. appealed to the Supreme Court of Wisconsin.

Ruling and Rationale

The Supreme Court of Wisconsin agreed with M.A.C. that she should have been given direct notice of the recommitment proceedings, that default judgment was in error, and that insufficient evidence had been given to justify the circuit court’s order to continue involuntary medication.

The court examined the plain text of Wisconsin’s civil commitment statute, which states that “the petitioner’s counsel shall notify the subject individual and his or her counsel of the time and place of the final hearing” (Wis Stat. § 51.20(10)(a)). Based on “the plain, clear words of the statute” (M.A.C., p 372), the court determined that the legislature requires that notice be given to both the subject individual and counsel and that attempting to deliver notice to a subject individual via counsel is insufficient. In coming to their decision, the court overruled Waukesha County v. S.L.L., 929 N.W.2d 140 (Wis. 2019). In S.L.L., also a case regarding recommitment proceedings, the court ruled that “‘notice to counsel …was sufficient’ under our statutes” (M.A.C., p 373). In M.A.C., the court determined that this prior holding was “unsound because the S.L.L. court did not adequately address the plain text of Wis. Stat. § 51.20(10)(a)” (M.A.C., p 373). Thus, the court determined that M.A.C.’s due process rights were violated because she was not given personal notice of the recommitment proceedings.

The court also agreed with M.A.C. that default judgment should not be available in recommitment and involuntary medication hearings, noting that this would “shortchange subject individuals by depriving them of a commitment hearing” (M.A.C., p 376). The Wisconsin Supreme Court concluded that, if a subject individual does not appear for a recommitment hearing, the two options available are to either detain the individual and hold a final hearing within seven days of detention or to adjourn and hold another hearing prior to the commitment’s expiration.

Finally, the county carries the burden to prove, by clear and convincing evidence, that the subject individual requires involuntary medication. The court held that the county provided insufficient evidence to meet this standard, citing Addington v. Texas, 441 U.S. 418 (1979), and noting that involuntary medication hearings cannot simply be “perfunctory.” Wis Stat. § 51.61(1)(g)) (2023) requires that petitions for involuntary medication orders “shall include a statement …based on an examination of the individual by a licensed physician” demonstrating that the subject individual is “incapable of expressing an understanding of the advantages and disadvantages of accepting medication or treatment and the alternatives” or is “substantially incapable of applying an understanding of the advantages, disadvantages, and alternatives to his or her mental illness, developmental disability, alcoholism, or drug dependence to make an informed choice as to whether to accept or refuse medication or treatment.” The court noted that the court-appointed physicians did not explain the disadvantages, advantages, and alternatives to medication to M.A.C. and the court only relied on these physician reports in ordering involuntary medication. The county did not call other witnesses or enter other information into evidence to support its argument that M.A.C. was incompetent to refuse medication. Thus, the government did not meet the required standard of proof.