In re MH – 5/29/2009

May 29, 2009

Arizona Court of Appeals Division One Holds That A.R.S. § 36-533, Addressing Psychiatric Examinations Required For Involuntary Treatment, Requires a Personal Examination of the Patient.

MH was ordered to be detained and evaluated to determine whether he should be required to undergo involuntary psychiatric treatment.  He was admitted to a hospital after resuming his medication.  At the hospital, he was evaluated by two doctors, including Dr. Kamala Premkumar.  After those evaluations, the hospital’s medical director filed a petition for court-ordered treatment, alleging that MH was persistently or acutely disabled and attaching the affidavits of the two treating doctors.  At the competency hearing, the Court found that MH was persistently or acutely disabled, in need of treatment, and unwilling or unable to accept voluntary treatment.  The Court ordered that MH complete inpatient/outpatient psychiatric treatment.  MH appealed, arguing that Dr. Premkumar did not examine him as required by statute, and as a result, the State’s evidence was insufficient to sustain the court’s order.

Division One vacated the involuntary treatment order.  Reviewing for clear error, the Court began by noting that involuntary treatment proceedings must strictly follow the statutory requirements set forth in A.R.S. §§ 36-501 – 550.08.  The process for involuntary treatment begins with the petition for evaluation.  An “evaluation” is defined as “a professional multidisciplinary analysis . . . carried out by . . . two licensed physicians, who shall be qualified psychiatrists, if possible . . . and who shall examine and report their findings independently. . . .”  An “examination” is defined as “an exploration of the person’s past psychiatric history and of the circumstances leading up to the person’s presentation, a psychiatric exploration of the person’s present mental condition and a complete physical examination.”  If the evaluation determines that as a result of a mental disorder the patient is “a danger to self or others, is persistently or acutely disable or is gravely disabled,” the medical director at the evaluating agency can file a petition for involuntary treatment.  The petition shall be accompanied by the affidavits of the two physicians who conducted the evaluation.

At MH’s competency hearing, Dr. Premkumar testified that MH was asleep when she tried to examine him and that she was unable to wake him.  She stated that his medication’s side effects likely contributed to MH’s inability to engage in the examination.  She admitted that she did not conduct a physical exam.  Thus, her affidavit submitted with the petition was not based on a personal examination, but on information, Dr. Premkumar received from reviewing the petition and MH’s recent medical records. 

The Court concluded that A.R.S. § 36-533 “requires the physician to personally examine the patient.”  The court so found based on the language of the statute, including its requirement of a “complete physical examination,” which in the psychiatric context includes “observing the patient’s demeanor and physical presentation,” which clearly would require a personal examination.  The court also cited analogous cases in the workmen’s compensation context.

Judge Portley authored the opinion, with Judges Thompson and Swann concurring.