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In the Interest of Rb v. Wyoming State Hospital

February 6, 2013


Appeal from the District Court of Park County The Honorable Steven R. Cranfill, Judge

The opinion of the court was delivered by: Davis, Justice.

Before KITE, C.J., and HILL, VOIGT, BURKE, and DAVIS, JJ.

NOTICE: This opinion is subject to formal revision before publication in Pacific Reporter Third. Readers are requested to notify the Clerk of the Supreme Court, Supreme Court Building, Cheyenne, Wyoming 82002, of any typographical or other formal errors so that correction may be made before final publication in the permanent volume.

[¶1] The Fifth Judicial District Court involuntarily hospitalized RB, a middle-aged man, at the Wyoming State Hospital after a period of emergency detention at West Park Hospital in Cody, Wyoming. He was detoxified of opiates and other controlled substances and eventually stabilized on psychotropic medications. The State Hospital gave notice that it intended to discharge RB, and the Park County Attorney's Office filed an objection with the district court, claiming a right to a hearing on the merits of the State Hospital's decision. The district court found that Park County had no statutory right to object to RB's discharge, and therefore had no standing to do so. We find that the involuntary hospitalization statutes do not provide authority for a county attorney to object to the proposed discharge of a patient from involuntary civil commitment, and we therefore affirm.


[¶2] Does a county attorney*fn1 have authority to object to a patient's discharge from involuntary civil commitment under Chapter 10 of Title 25 of the Wyoming Statutes?


[¶3] In late November of 2011, a mental health examiner filed an application to involuntarily hospitalize RB in the Fifth Judicial District Court for Park County. The application stated that RB was being emergently detained as a suicide risk pending a hearing on whether he should be involuntarily hospitalized at the Wyoming State Hospital. The district court appointed counsel for RB and set a hearing on both involuntary hospitalization and continued emergency detention. A deputy Park County attorney appeared on behalf of the State at that hearing, which took place before a court commissioner. The commissioner made findings of facts and recommended that RB be hospitalized at the State Hospital in Evanston, Wyoming. The district court adopted the commissioner's recommendations and entered an appropriate order.

[¶4] RB had a history of opiate dependence and opiate-induced depression beginning in 2000. The record suggests that RB had an injury or illness which was treated with opiates. This evidently led to addiction and subsequent drug-seeking behavior involving efforts to persuade health care providers that his condition required treatment with the substances to which he was addicted. Dr. Robert Hartmann, RB's treating psychiatrist at the State Hospital, found that other health care providers had in fact inappropriately prescribed opiates and other controlled substances in 2011, resulting in depression and suicidal ideation which led to RB's involuntary hospitalization.

[¶5] After RB was detoxified and stabilized on psychotropic medications to address mental illness, the State Hospital gave notice to the district court, RB's attorney, a community health center, and the Park County Attorney that conditions justifying involuntary hospitalization no longer existed, and that it therefore intended to discharge him in about eight days. Although it was not expressly stated in the notice, the conclusion that hospitalization was no longer justified implied a finding that RB was no longer a danger to himself or others as he had been when involuntarily hospitalized.

[¶6] The Park County Attorney filed an objection to the State Hospital's medical determination, asserting that the district court should order RB's continued hospitalization because he had several prior emergency detentions and involuntary hospitalizations. Park County is obligated to pay for the first seventy-two hours of emergency detention, and believes that it should not be required to incur the expense of doing so repeatedly without an opportunity to demonstrate that the patient should not be discharged. See Wyo. Stat. Ann. § 25-10-112(a)(i)(A) (LexisNexis 2011). It appears from the record that Park County's interest in objecting to RB's discharge was largely if not entirely financial.

[¶7] The State Hospital then submitted a discharge plan which reiterated that RB had stabilized and that he was fully capable of managing his own affairs. The court set a hearing in which RB, his treating psychiatrist Dr. Hartmann, and the Wyoming Attorney General's Office participated by telephone.

[¶8] Dr. Hartmann, who was called by the Attorney General's Office, was the only witness at the hearing. He testified that RB was almost completely detoxified when he arrived at the State Hospital on December 6, 2011, and that he was therefore essentially physically and mentally normal at that time. RB gave Dr. Hartmann a history of opiate dependence, including a relapse in late September of 2011. Instead of being detoxified and released from other health care facilities after his relapse, he was unfortunately given even larger doses of opiates and benzodiazepines by those care providers, and as a result became suicidal.

[¶9] Dr. Hartmann testified that RB indicated that he had never attempted suicide, and that he always sought help when he was in trouble. He concluded that RB's current problems were caused by medications supplied by professional healthcare providers. RB was a cooperative patient, although he did engage in drug-seeking behavior consistent with his addiction. Dr. Hartmann concluded that continued involuntary hospitalization at the State Hospital was inappropriate because the patient had been detoxified and was no longer suicidal. He testified that the State Hospital does not treat substance abuse problems, including addiction to opiates, and therefore had nothing to offer RB in that respect.

[¶10] In cross-examination, the deputy county attorney sought to establish that persons at risk for suicide may not be forthright about prior suicide attempts. Dr. Hartmann admitted that he had not seen all of RB's medical and psychological records or interviewed his family. He reiterated his conclusion that RB spoke of committing suicide only when intoxicated with opiates.

[¶11] Although it conducted the hearing described above, the trial court found that the statute governing discharge from involuntary hospitalization did not allow a county attorney to object to the State Hospital's decision to discharge an involuntarily hospitalized patient, or to obtain an evidentiary hearing concerning that decision. The evidence just described was not therefore significant to its ruling. This appeal was timely perfected.

[¶12] RB did not participate in this appeal. In criminal cases, a county attorney or district attorney represents the State of Wyoming. See Wyo. Stat. Ann. §§ 9-1-801, 804 (LexisNexis 2011) (delineating the judicial districts in which the district attorney prosecutes criminal cases on behalf of the State, as opposed to the county attorney); Wyo. Stat. Ann. § 18-3-301 (LexisNexis 2011) ("In judicial districts in which the office of district attorney has not been created there shall be elected in each county a county and prosecuting attorney . . . ."). In this case, however, it is clear that the Park County Attorney represents the interests of Park County. We will therefore refer to those interests as those of the county attorney or Park County rather than of the State. The State Hospital is, of course, a sub-agency of the State of Wyoming.


[¶13] The district court framed its decision in terms of standing, and the parties also identified standing as an issue in their briefs. The concept of standing limits a private citizen or organization's right to challenge the actions of government in the courts to those cases in which the challenger presents a justiciable controversy, among other things. See, e.g., Miller v. Wyoming Dep't of Health, 2012 WY 65, ¶ 17, 275 P.3d 1257, 1261 (Wyo. 2012).

[¶14] As a political subdivision of the State, a county has no powers other than those granted by Wyoming's constitution or its statutes, as well as those powers which can reasonably be implied from expressly granted powers. Bd. of Cnty. Comm'rs for Sublette Cnty. v. Exxon Mobil Corp, 2002 WY 151, ¶ 22, 55 P.3d 714, 721 (Wyo. 2002) (citing River Springs Ltd. Liability Co. v. Bd. of Cnty. Comm'rs of Cnty. of Teton, 899 P.2d 1329, 1335 (Wyo. 1995); Dunnegan v. Laramie Cnty. Comm'rs, 852 P.2d 1138, 1142 (Wyo. 1993)).

[¶15] The parties agree that the ability of Park County to challenge a discharge from the State Hospital and to obtain an evidentiary hearing on the propriety of that discharge depends on whether or not it has statutory authority to do so. It is more fitting to speak of the authority granted to counties under the involuntary hospitalization statutes than to frame the issue as one of standing. It is appropriate for this Court to review controversies like this in which a political subdivision and a State agency seek a construction of applicable statutes and a determination of their correlative rights. Carbon Cnty. Sch. Dist. No. 2 v. Wyo. State Hosp., 680 P.2d 773, 775 (Wyo. 1984).

[¶16] District court decisions interpreting statutes involve questions of law, requiring de novo review by this Court. Exxon Mobil Corp., ¶ 7, 55 P.3d at 718 (citing Sellers v. Dooley Oil Transp., 2001 WY 44, ¶ 10, 22 P.3d 307, 309 (Wyo. 2001)). The basic rules of statutory construction are well established:

We endeavor to interpret statutes in accordance with the

Legislature's intent. We begin by making an inquiry respecting the ordinary and obvious meaning of the words employed according to their arrangement and connection.

When the court determines, as a matter of law, that a statute is clear and unambiguous, it must give effect to the plain language of the statute and should not resort to the rules of statutory construction. If, on the other hand, the Court determines that a statute is ambiguous, it may use extrinsic ...

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