Believing a Feb. 6 decision from the Supreme Court opened him up to civil liability, Park County Attorney Bryan Skoric stopped his office’s practice of reviewing requests for emergency detentions and prosecuting the ones he deemed appropriate.
A request to detain an individual comes when a law enforcement officer or a mental health examiner — most often personnel from Yellowstone Behavioral Health — deems a person to be a danger to himself/herself or others as a result of mental illness. The detentions are known as Title 25 commitments, a reference to the chapter of state law they fall underneath.
Skoric interprets the Supreme Court decision as saying his office has no duty to handle emergency detentions. He told the Tribune in February that the set-up was going to be “a little odd, to say the least, because the process that’s been followed forever is now gone.” He said he had “no idea” how the cases would be prosecuted.
As it turns out, the duty of bringing those requests to a District Court commissioner or judge has been — grudgingly — taken up by an attorney for West Park Hospital and Yellowstone Behavioral Health.
“The burden shouldn’t be on the hospital,” said the health organizations’ attorney, Chris Edwards of Simpson, Kepler and Edwards in Cody. “The hospital is a healthcare provider, and the public interest should be represented and the patient’s protections should be represented by the county attorney.”
Edwards says Skoric misinterpreted the Supreme Court’s decision. She asked District Court Judge Norman Young to force Skoric’s office to continue reviewing and prosecuting emergency detentions. Judge Young declined to do so in an April 2 decision, saying Skoric’s interpretation may be correct.
Edwards argued that Skoric’s departure gives the patients — who continue to be represented by their own attorney at the hearings — fewer rights. She said the county attorney should be determining which individuals should be committed and ensuring their civil rights are upheld.
Skoric didn’t necessarily dispute that general argument.
“It may very well be that the county attorneys are the best situated to file these cases on behalf of examiners, but that is something for the Legislature to determine,” he said.
Judge Young echoed that idea in his opinion.
“There are many reasons why it might be preferable to have the county attorney involved in the emergency detention proceedings. ... Such proceedings involve public safety, public funds and most importantly and most assuredly, the safety, the well being and the liberty of proposed patients,” Young wrote. However, he said the Legislature — despite having been begged and pleaded to clarify the statutes for years — has not seen fit to define a role for the county attorney in the commitment process.
The Wyoming Supreme Court decision by Justice Michael Davis described Wyoming’s involuntary commitment statutes as “ambiguous.”
The decision also illustrated how complicated they are.
The controversy between West Park and Skoric effectively comes from one sentence in Davis’ 15-page ruling. The gist of the decision was that county attorneys cannot block a patient’s release from the state mental hospital (see related story). But towards the end of the opinion, Davis included a line that — summarized briefly — can be interpreted as saying county attorneys don’t have an obligation to appear at the initial emergency hearings after an individual is detained.
Up until the Supreme Court’s decision, Skoric had reviewed, filed and presented the cases for emergency detention to the District Court, putting the examiners on the stand to explain why hospitalization was necessary. Now that job has fallen to the hospital’s attorney.
“We are clearly not charged with this duty,” Edwards said. She said the hospital fears it’s opening itself up to litigation from patients by handling the cases. But Skoric said in lieu of the Supreme Court decision, he believes he’d be opening his office up to liability by continuing to handle them.
Skoric will continue to appear at involuntary hospitalization hearings that are held later, if and when patients contest the idea they should be hospitalized.
The Legislature’s Joint Judiciary Interim Committee has listed possible reform of the state’s mental health and involuntary commitment procedures “to reduce costs to the state” as its second-highest priority between now and the 2014 Budget Session.
The committee is scheduled to have its first meeting May 13 and 14 in Jackson.
Skoric, a longtime critic of state law that guides the involuntary hospitalizations, urged the Legislature to “address this mess.”
“I’ve long said ... the Legislature does not understand Title 25, they never have, and it’s time that they do. Reach out there and really study this issue,” Skoric said in a February interview. “You can’t fix this problem that’s consistent throughout the state with a few one- or two-hour hearings held throughout the summer in formulating a bill and pretending that everybody understands it. It does not work.”
Edwards said West Park and Yellowstone Behavioral Health are not sure yet what they’ll do next.
“We’re committed to making sure our patients are cared for, and we’re just deciding now what our next steps will be,” Edwards said on Friday. She did say that, “We think waiting until the next legislative session will be too long.”
Court: County attorney can’t object to patients’ release
By CJ BAKER
Tribune Staff Writer
If a person is deemed mentally stable and cleared to leave the Wyoming State Hospital, the Park County Attorney’s Office cannot disagree and seek to keep them institutionalized, the Wyoming Supreme Court recently ruled.
The court’s ruling came after Park County Attorney Bryan Skoric’s office asked to stop a man’s release from the state’s care on the grounds he could relapse in the future.
“We just want to see a discharge plan from the state hospital that gives the community some guarantee we’re not going to continue with the revolving door,” Skoric said in a February interview with the Tribune, referring to patients being repeatedly discharged and re-committed.
The case in question involved a middle-aged man who’d reportedly been under the influence of narcotics and expressing thoughts of suicide when involuntarily committed to the state’s care in late 2011. According to the Supreme Court’s ruling, he’d been committed “several” times before.
The Wyoming State Hospital in Evanston helped detoxify the man, stabilized him with psychotropic medication and prepared to release him. Skoric’s office objected to the release. Skoric said the objections had been made before in a small number — perhaps 5 percent — of cases. Skoric said District Court Judge Steven Cranfill had agreed with his objections and kept an individual committed before. In this November 2011 instance, however, Cranfill ruled Skoric lacked the authority to object.
Skoric appealed to the Supreme Court and the five justices unanimously ruled against him.
Justice Michael Davis conceded the man may be hospitalized again, as Deputy Park County Attorney William Struemke had argued.
“Nonetheless,” the justice wrote. “There is no legal basis for continuing involuntary hospitalization based only on a possibility that a patient who is not currently mentally ill ... will in the future become ill again based on his past behavior.
“If further episodes occur, the patient’s liberty may be restrained through involuntary hospitalization only upon proof of mental illness by clear and convincing evidence, not on the basis of speculation or possibilities,” Davis said.
Later in the opinion, Davis said it’s understandable that Park County is frustrated by having to pay for patients who are repeatedly deemed to be threats to themselves or others and committed.
“Many who suffer from mental illness or addiction never completely vanquish the demons controlling their lives, but instead manage only to hold them at bay for what may be discouragingly brief periods of time,” Davis wrote. In those instances, he noted considerable expense to the state and counties can follow. Repeated commitments are a bigger issue for counties, because they must pay for the first 72 hours of care each time an individual is committed. The state covers the rest.
Justice Davis said the question of whether the current law unfairly burdens counties should be addressed with the Legislature and not the courts.
In the appeal to the Supreme Court, Struemke asked why the law requires his office to be notified when a patient is being released if it doesn’t have the power to object and provide a check on the system.
Justice Davis, however, said there are other reasons for the notifications. As examples, he said county attorneys could then proceed with any criminal charges or pass along a heads up to law enforcement.
The justice noted a discharge is a medical determination by staff at the State Hospital.
“It is difficult to conceive of a reason that the Legislature, having created this specialized institution, would choose to empower often-overworked local county attorneys without staffs qualified to evaluate mental illness to assess and challenge a discharge decision made by the specialists employed by that institution,” Davis wrote.
The court found the law allows only patients — who sometimes want to continue receiving treatment — to object to their discharge from state care.
Skoric is critical of the State Hospital system and certain patients being seen over and over.
“That’s what we see lately with the State Hospital — all they do is stabilize them. They don’t treat them,” Skoric said.
In the case before the Supreme Court, the man’s treating psychiatrist at the State Hospital, Dr. Robert Hartmann, testified other health care providers had inappropriately prescribed the man opiates and other controlled substances. The man was actually addicted to those drugs and the narcotics led to his depression, thoughts of suicide and involuntary hospitalization, Hartmann said.
The man finished his detoxification in state care in Evanston, received medication and then was prepared to be released, the decision says. The State Hospital, Hartmann noted in comments quoted by Justice Davis, is not a substance abuse treatment facility and therefore has nothing to offer people struggling with drug addictions.
Skoric has said in the past that many involuntary commitments involve substance abuse.