In a decision released Friday, the Vermont Supreme Court ruled in favor of a man with mental health issues from Windham County who asked not to be medicated against his will. The ruling found fault with state officials from the Vermont Department of Mental Health who had obtained an order of involuntary medication.
The order, which does not name the 34-year-old patient, looked at two questions: Whether the Vermont Family Court had a right to review the advanced directive created by the patient to block involuntary medication, and whether the family court had found the proper evidence to support the order that the patient be medicated without his permission.
While the decision, signed by Justice Paul Reiber, agreed the state had an interest in making sure the advance directive was valid, the justices also found that the state hadn’t found enough evidence to justify going against the patient’s wishes.
The patient was first diagnosed with schizophrenia when he was 12. He was staying at the Brattleboro Retreat as the Vermont Supreme Court appeal was underway and it’s his sixth stay at the retreat.
“Patient has a history of unpredictable violence and unprovoked aggression toward hospital and treatment facility staff, police and others. Patient has also exhibited catatonia or periods of immobility and inability to respond to others and the elements around him,” the decision said.
During his 2017 stay at the retreat, the patient was given a specific trifluoromethyl phenothiazine derivative, used to treat schizophrenia. During that period, the patient was able to maintain an apartment and a job, and he could effectively communicate with other people.
However, the patient wrote in a statement in July 2017 that the medication altered his mood, had a negative affect on his memory and ability to think clearly, and caused physical discomfort.
The patient executed an advance directive in August 2017, in which he wrote, “I want no neuroleptics or antipsychotics under any circumstances. I want no psychiatric drugs including mood stabilizers. I want no medications I do not desire at the time.”
The patient said he would not consent to having someone acting as his designated agent authorizing medication. He also checked a box that said he understood the directive could lead to longer or involuntary stays in the hospital
After the patient stopped taking the drug, his schizophrenic symptoms got worse and he pushed a staff member at the Retreat and hurt her. He was checked into the Retreat as an involuntary patient and committed to the care of the Vermont Department of Mental Health in June 2018.
After a two-day hearing in September 2018, the family court approved the application for involuntary medication.
Reiber’s decision notes that Vermont law requires an advanced directive to be written by an adult who has capacity, or “an individual’s ability to make and communicate a decision regarding the issue that needs to be determined.”
The decision said the family court has a legitimate interest in making sure the person who executed the advanced directive had capacity at the time it was created before deciding if there was reason to override the decision.
“We agree with patient that the court’s determination that patient lacked capacity to execute the advance directive is not supported by clear and convincing evidence. Although patient has been found incompetent in the past … this does not mean that he was incompetent in August 2017 when the advance directive was executed,” the decision said.
As required by law, the directive was signed by two witnesses.
Dr. Thomas Simpatico testified in the case that the patient was a “bright guy” who “reads a lot and researches things.” He developed “strong opinions” about the medications he had been prescribed, Simpatico said.
Reiber wrote that just because the patient “chose to reject a medication that his providers observed to improve his condition does not automatically mean that he did not understand the decision he was making.”
Also, the state’s top court rejected the family court’s suggestion that the “patient lacked capacity merely because he continued to have a mental illness.”
The decision reversed the family court’s ruling from Dec. 19 and vacated the order for involuntary medication.