Dane County v. M. A. A.

COURT OF APPEALS
DECISION NOTICE
DATED AND FILED This opinion is subject to further editing. If
published, the official version will appear in
the bound volume of the Official Reports.
December 27, 2024
A party may file with the Supreme Court a
Samuel A. Christensen petition to review an adverse decision by the
Clerk of Court of Appeals Court of Appeals. See WIS. STAT. § 808.10
and RULE 809.62.

Appeal No. 2024AP1589-FT Cir. Ct. No. 2023ME477

STATE OF WISCONSIN IN COURT OF APPEALS
DISTRICT IV

IN THE MATTER OF THE MENTAL COMMITMENT OF M.A.A.:

DANE COUNTY,

PETITIONER-RESPONDENT,

V.

M.A.A.,

RESPONDENT-APPELLANT.

APPEAL from an order of the circuit court for Dane County:
STEPHEN E. EHLKE, Judge. Affirmed.

¶1 TAYLOR, J.1 M.A.A. appeals an involuntary medication order that
was issued in tandem with an order for his involuntary commitment because of

1
This appeal is decided by one judge pursuant to WIS. STAT. § 752.31(2)(d) (2021-22).
All references to the Wisconsin Statutes are to the 2021-22 version unless otherwise noted.
No. 2024AP1589-FT

mental illness pursuant to WIS. STAT. § 51.20. M.A.A. contends that Dane County
(“the County”) failed to prove by clear and convincing evidence that M.A.A. was
incompetent to refuse medication under WIS. STAT. § 51.61(1)(g)4.b., and that
some of the circuit court’s factual findings were clearly erroneous. I reject
M.A.A.’s arguments and affirm.

BACKGROUND

¶2 On November 29, 2023, M.A.A. was taken into custody on an
emergency detention. According to the detaining officer, M.A.A. had threatened
his roommate with physical violence and believed that his roommate had been
poisoning M.A.A.’s and M.A.A.’s mother’s food.

¶3 On December 1, 2023, after holding a hearing, the circuit court
determined that there was probable cause for a WIS. STAT. ch. 51 commitment and
an involuntary medication order. The court ordered that M.A.A. be detained at an
inpatient facility pending the final hearing on the commitment, administered
medication and treatment regardless of his consent, and be examined by Dr. Leslie
Taylor, a psychiatrist, and Dr. Michael Lace, a psychologist. Drs. Taylor and Lace
each examined M.A.A. and provided independent reports to the court of their
examinations that were admitted into evidence at the final hearing.

¶4 On December 11, 2023, the circuit court held the final hearing
regarding M.A.A.’s involuntary commitment and medication. Cumulatively,
Drs. Taylor’s and Lace’s testimony, examination reports, and review of collateral
sources, including interviews with M.A.A.’s mother and roommate, set forth the
following. M.A.A. has a history of mental illness and suffers from a
schizophrenia spectrum disorder that is exacerbated by medication noncompliance
and for which M.A.A. has been repeatedly hospitalized. M.A.A. has a history of

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setting fires, which limits his housing options, such that, at the time of the
emergency detention, he was living with his mother and a roommate. His mother
reported that, since M.A.A.’s release from his prior commitment, she believed that
he had not been taking his medication, was setting fires, was paranoid, shut off all
the electronics in the house, did not sleep, and often left the house in the middle of
the night to go jogging.

¶5 M.A.A.’s roommate testified at the final hearing that M.A.A. had
stopped taking his medication, accused the roommate of poisoning him, and
demanded that the roommate not cook for him or touch his or M.A.A.’s mother’s
food. On the night when police were called, M.A.A. told the roommate he would
“beat [his] ass” if M.A.A. or M.A.A.’s mother touched the food the roommate was
making. Several weeks prior, M.A.A. had twisted his mother’s arm with such
force that she had to wear a sling around her arm for two weeks and could not
work.

¶6 When he was brought to Winnebago Mental Health Institute
(“WMHI”) for the emergency detention, M.A.A. was observed to be paranoid,
ungroomed, and using his mouth instead of his hands to pick up items. The
examination reports collectively concluded that M.A.A. was actively symptomatic
for untreated schizophrenia, and he displayed psychotic symptoms such as
disorganized thinking, poor impulse control, and impaired judgment and insight.
Both examiners and the circuit court concluded that M.A.A. satisfied the criteria
for involuntary commitment under WIS. STAT. § 51.20(1)(a)2.b., in that, because
of his mental illness, there was a substantial probability M.A.A. would cause
physical harm to others. This determination is not challenged on appeal.

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No. 2024AP1589-FT

¶7 With respect to involuntary medication under WIS. STAT.
§ 51.61(1)(g), for many of the reasons stated above, Drs. Taylor and Lace
concluded in their testimony and examiner reports that M.A.A. was not competent
to refuse medication. Cumulatively, Drs. Taylor’s and Lace’s testimony and
examination reports stated the following. M.A.A. had not been compliant with
taking oral mental health medication after the expiration of his prior involuntary
commitment. In this case, at the time of his emergency detention at WMHI,
M.A.A. refused to take Invega, a psychotropic medication that had previously
been prescribed for him. At the December 1, 2023 probable cause hearing, the
court commissioner ordered that M.A.A. be involuntarily medicated. During the
examinations, held on December 4 and 5, 2023, M.A.A. denied that he had a
mental illness, refused to identify his mental health diagnosis, and insisted that he
was misdiagnosed and had no signs or symptoms of mental illness. As stated,
both examiners observed M.A.A. to be experiencing symptoms of schizophrenia
that impaired his judgment and insight into his mental illness and his treatment
need for antipsychotic medication.

¶8 Dr. Taylor recommended that M.A.A. be involuntarily administered
Invega, and she testified that she discussed with M.A.A. the risks, benefits, and
alternatives to Invega. According to Dr. Taylor, M.A.A. was substantially
incapable of applying this information to his mental illness because his judgment
and insight were impaired by his schizophrenia such that he was adamant that he
was not mentally ill, he felt he was doing quite well not taking medication, and he
saw no need to resume taking medication.

¶9 After the County presented its evidence, M.A.A. testified that he was
currently prescribed medication and that this medication had “sort of” improved
his mental health in the past. M.A.A. also testified that he preferred Invega over

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No. 2024AP1589-FT

Abilify (a different psychotropic medication) because he was “used to it.” When
asked if he would choose to continue taking medication, he responded “Yes, but I
don’t believe I am --” before his counsel interrupted his answer.

¶10 The circuit court concluded that the County met its burden of
proving that M.A.A. satisfied the criteria for involuntary commitment and ordered
that M.A.A. be committed to a locked facility for six months. The court also
concluded that the County met its burden of proving that M.A.A. satisfied the
criteria for involuntary medication, stating:

I suspect he probably will get better and better. And there’s
no doubt he is moving towards, but I don’t think he’s yet at
the point that he does completely understand the
advantages, disadvantages, and alternatives to his or her
condition in order to make an informed choice as to
whether to accept or refuse psychotropic medications.

The court’s written order states that, because of M.A.A.’s “mental illness,”
M.A.A. is “substantially incapable of applying an understanding of the
advantages, disadvantages and alternatives to his … condition in order to make an
informed choice as to whether to accept or refuse psychotropic medications.”
M.A.A. appeals.2

2
M.A.A.’s six-month commitment and involuntary medication orders expired in
June 2024, and the County did not seek extensions. M.A.A. argues that his appeal of the expired
involuntary medication order is not moot due to the collateral consequences of that order, namely
his liability for the costs of care related to the medication order. See WIS. STAT. § 46.10(2)
(providing that a person committed under WIS. STAT. ch. 51 “shall be liable for the cost of the
care, maintenance, services[,] and supplies”); see also Sauk County v. S.A.M., 2022 WI 46, ¶¶24-
27, 402 Wis. 2d 379, 975 N.W.2d 162 (holding that an appeal of an expired recommitment order
was not moot, in part, because the individual was still liable for the costs of care under
§ 46.10(2)). Because the County does not dispute M.A.A.’s argument that his appeal of the
involuntary medication order is not moot, the issue is conceded by the County. See Shadley v.
Lloyds of London, 2009 WI App 165, ¶26, 322 Wis. 2d 189, 776 N.W.2d 838 (“Arguments not
rebutted on appeal are deemed conceded.”).

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No. 2024AP1589-FT

DISCUSSION

I. Standard of Review and Governing Legal Principles

¶11 The County bears the burden of proving by clear and convincing
evidence that M.A.A. is incompetent to refuse medication. Outagamie County v.
Melanie L., 2013 WI 67, ¶37, 349 Wis. 2d 148, 833 N.W.2d 607. Whether the
County has met its burden presents questions of fact and law. Waukesha County
v. J.W.J., 2017 WI 57, ¶15, 375 Wis. 2d 542, 895 N.W.2d 783. This court
upholds a circuit court’s findings of fact unless they are clearly erroneous, but
independently reviews whether the facts satisfy the statutory standard. Id.

¶12 Under WIS. STAT. § 51.61(1)(g) and the liberties protected by the
Fourteenth Amendment, a person who has been involuntarily committed under
WIS. STAT. ch. 51 has the right to refuse medication and treatment.
Sec. 51.61(1)(g)1.; Melanie L., 349 Wis. 2d 148, ¶¶42, 43 (“[C]ompetent
individuals have a protected Fourteenth Amendment liberty interest in refusing
unwanted medical treatment” and “retain a ‘significant’ liberty interest in avoiding
forced medication of psychotropic drugs.” (internal quotation marks and citation
omitted)). However, a person who has been committed does not have the right to
refuse medication if the circuit court “makes a determination, following a hearing,
that the individual is not competent to refuse medication.” Sec. 51.61(1)(g)3.

¶13 The standard for determining competency to refuse medication is set
forth in WIS. STAT. § 51.61(1)(g)4. As relevant to this appeal, this statute
provides:

[A]n individual is not competent to refuse medication or
treatment if, because of mental illness, … and after the
advantages and disadvantages of and alternatives to

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No. 2024AP1589-FT

accepting the particular medication or treatment have been
explained to the individual, one of the following is true:

a. The individual is incapable of expressing an
understanding of the advantages and disadvantages of
accepting medication or treatment and the alternatives.

b. The individual is substantially incapable of
applying an understanding of the advantages, disadvantages
and alternatives to his or her mental illness … in order to
make an informed choice as to whether to accept or refuse
medication or treatment.

Sec. 51.61(1)(g)4.

¶14 As noted, each examiner determined that M.A.A. met the criteria
under WIS. STAT. § 51.61(1)(g)4.b. for involuntary medication, and the circuit
court concluded in its written involuntary medication order that the County had
met its burden of proof pursuant to § 51.61(1)(g)4.b.

II. There Was Sufficient Evidence to Support
Involuntary Medication

¶15 On appeal, M.A.A. does not dispute that he has a “mental illness,”
but he asserts that there was insufficient evidence to support the circuit court’s
findings of the other criteria required by WIS. STAT. § 51.61(1)(g)4.b. and that the
court made erroneous findings. For the following reasons, I reject M.A.A.’s
arguments.

A. Explanation of the Advantages and Disadvantages
of and Alternatives to Invega

¶16 First, M.A.A. argues that the County did not provide sufficient
evidence that he was given a proper explanation of the “advantages and
disadvantages of and alternatives to accepting” the proposed medication, which, in
this case, was Invega. See WIS. STAT. § 51.61(1)(g)4.b. I disagree. As previously

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No. 2024AP1589-FT

noted, prior to Dr. Taylor’s evaluation, Invega was being involuntarily
administered to M.A.A. Dr. Taylor testified that she recommended that M.A.A.
be administered Invega because M.A.A. had previously taken and done well on
this medication and that she discussed the “risks, benefits, and alternatives” to
Invega with M.A.A. In her examination report, Dr. Taylor further described the
specific advantages and disadvantages of and alternatives to Invega that she
discussed with M.A.A. Dr. Taylor wrote in her examination report that she
provided this information to M.A.A. during her thirty-minute examination of
M.A.A. Based on Dr. Taylor’s testimony and report, I conclude that the County
proved by clear and convincing evidence that M.A.A. was given a proper
explanation of the advantages and disadvantages of and alternatives to Invega.

¶17 M.A.A. argues that Dr. Taylor’s explanation was not sufficient
because she did not provide M.A.A. with an explanation of the nature of his
mental illness. This argument fails because WIS. STAT. § 51.61(1)(g)4. requires
only that an explanation of the “advantages and disadvantages of and alternatives
to accepting the particular medication” be given to the person. M.A.A. does not
point to any legal authority that interprets this language in § 51.61(1)(g)4. as
requiring an explanation of the nature of the person’s mental illness.3

3
As additional support for this argument, M.A.A. references a portion of this court’s
decision in State v. J.D.B., 2024 WI App 61, ¶75, ___ Wis. 2d ___, 13 N.W.3d 525. However, as
discussed in more detail below, the portion of J.D.B. on which M.A.A. relies involves the
causation element of WIS. STAT. § 51.61(1)(g)4.b.—i.e., that a person’s inability to apply an
understanding of the advantages and disadvantages of and alternatives to a recommended
medication be caused by the person’s mental illness—not the requirement that the person be
given an explanation of the advantages and disadvantages of and alternatives to the recommended
medication.

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No. 2024AP1589-FT

B. Because of Mental Illness

¶18 Next, M.A.A. argues that the County did not provide sufficient
evidence that M.A.A.’s inability to apply to his mental illness an understanding of
the advantages and disadvantages of and alternatives to Invega was “because of
mental illness.” See WIS. STAT. § 51.61(1)(g)4. This provision of § 51.61(1)(g)4.
requires proof of a causal connection between the person’s mental illness and the
person’s inability to apply an understanding of the advantages, disadvantages, and
alternatives to medication to their mental illness in order to make an informed
decision about medication. See State v. J.D.B., 2024 WI App 61, ¶70, ___
Wis. 2d ___, 13 N.W.3d 525 (explaining that this standard requires proof that the
person’s inability to apply an understanding of the advantages, disadvantages, and
alternatives of medication to their mental illness was “because of mental illness”
and “not some other cause”).4

¶19 M.A.A. argues that the testimony from Dr. Taylor was insufficient to
support the circuit court’s finding that M.A.A.’s inability to apply an
understanding of the advantages and disadvantages of and alternatives to
medication to his mental illness was “because of mental illness.” According to
M.A.A., Dr. Taylor testified that M.A.A.’s schizophrenia symptoms were
distorting his thinking and judgment and that M.A.A. lacked insight into his
mental illness, but she never testified that his schizophrenia symptoms were the

4
This court’s decision in J.D.B. was based on the involuntary medication standard for
competency to stand trial under WIS. STAT. § 971.14(3)(dm), which uses the same involuntary
medication standard applied in an involuntary commitment. See WIS. STAT. § 51.61(1)(g)4.;
J.D.B., ___ Wis. 2d ___, ¶69, 13 N.W.3d 525 (“Under … § 971.14(3)(dm), the State must show
that [the defendant] was told ‘the advantages and disadvantages of and alternatives to accepting
the particular medication or treatment[.]’”).

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No. 2024AP1589-FT

cause of his lack of insight into his mental illness. In support, M.A.A. points to a
portion of J.D.B. in which this court stated:

[I]t was [the doctor’s] responsibility to explain how [they]
probed the issue of why [the individual] did not believe he
needed medication. Probing this issue was necessary for
the circuit court to determine if [the individual]’s lack of
understanding was “because of mental illness” as required
by the statute and not some other cause.

J.D.B., ___ Wis. 2d ___, ¶70, 13 N.W.3d 525. I am unpersuaded.

¶20 Here, Dr. Taylor’s testimony shows that she probed the issue of the
causal connection between M.A.A.’s schizophrenia and his inability to apply an
understanding of the advantages and disadvantages of and alternatives to Invega to
his mental illness. First, M.A.A. denied having a mental illness and experiencing
the symptoms of mental illness. These symptoms, which included distorted and
delusional thinking, paranoia about food, aggressive behavior, and unintelligible
speech, impaired M.A.A.’s judgment such that he had no insight into his mental
illness and was adamant that he was not mentally ill and that he was doing well
without medication. Second, although M.A.A. is correct that Dr. Taylor did not
explicitly state that M.A.A.’s distorted thinking and judgment was the reason he
lacked insight into his mental illness, it was reasonable for the circuit court to infer
from Dr. Taylor’s testimony that M.A.A.’s schizophrenia symptoms were causing
his inability to apply an understanding of the advantages and disadvantages of and
alternatives to the recommended medication to his mental illness. See Melanie L.,
349 Wis. 2d 148, ¶38 (“We accept reasonable inferences from the facts available
to the circuit court.”). Nothing in J.D.B. precludes a court from making
reasonable inferences from the evidence presented when determining whether the
County has met its burden of proof.

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No. 2024AP1589-FT

¶21 For these reasons, I conclude that the County proved by clear and
convincing evidence that M.A.A.’s mental illness was the cause of his inability to
apply to his mental illness an understanding of the advantages and disadvantages
of and alternatives to Invega in order to make an informed choice about taking or
refusing the medication.

C. Substantially Incapable of Applying an Understanding of
the Advantages, Disadvantages, and Alternatives of
Medication to His Mental Illness

¶22 M.A.A. also argues that the circuit court made a clearly erroneous
finding when it stated that M.A.A. did not “completely understand” the advantages
and disadvantages of and alternatives to Invega. M.A.A. argues that this oral
finding by the court is contrary to Dr. Taylor’s testimony that, although M.A.A.
understood the advantages and disadvantages of and alternatives to Invega, he
could not apply that understanding to his own mental illness in order to make an
informed decision about medication because he was in denial about being
mentally ill. According to M.A.A., this oral finding indicates that the court was
applying the incompetency standard set forth under WIS. STAT. § 51.61(1)(g)4.a.,
not the standard set forth under § 51.61(1)(g)4.b., which, M.A.A. argues, was not
supported by the evidence presented. For the following reasons, I reject M.A.A.’s
argument that the court’s oral finding was clearly erroneous.

¶23 First, M.A.A.’s argument misses the mark because it does not
accurately and fully recite the circuit court’s statement in its oral determination: “I
don’t think [M.A.A. is] yet at the point that he does completely understand the
advantages, disadvantages, and alternatives to his … condition in order to make an
informed choice as to whether to accept or refuse psychotropic medications.”
(Emphasis added.) The emphasized portion of the foregoing quote shows that the

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No. 2024AP1589-FT

court was partially applying the incompetency standard set forth under WIS. STAT.
§ 51.61(1)(g)4.b. Although the court’s oral determination omits the portion of the
statutory standard that M.A.A. is “substantially incapable of applying” an
understanding of the advantages and disadvantages of and alternatives to Invega to
his mental illness, the court’s written order accurately recites the standard set forth
under § 51.61(1)(g)4.b.:

[d]ue to … mental illness, … [M.A.A.] is not competent to
refuse psychotropic medication or treatment because
[M.A.A.] is … substantially incapable of applying an
understanding of the advantages, disadvantages and
alternatives to his … condition in order to make an
informed choice as to whether to accept or refuse
psychotropic medications.

¶24 Although the circuit court omitted several words in its oral
determination that are contained in its written order, “[a] trial court is not required
to recite ‘magic words’ to set forth its findings of fact.” State v. Echols, 175
Wis. 2d 653, 672, 499 N.W.2d 631 (1993). Therefore, although the court’s oral
determination was not a verbatim recitation of WIS. STAT. § 51.61(1)(g)4.b., any
ambiguity about the court’s stated determination was clarified by the unambiguous
determination set forth in the court’s written order. See Jackson v. Gray, 212
Wis. 2d 436, 443, 569 N.W.2d 467 (Ct. App. 1997) (“[W]here the oral
pronouncement is ambiguous, it is proper to look at the written judgment to
ascertain the court’s intention.” (alteration in original; citation omitted)).

¶25 Second, M.A.A. argues that the County failed to prove by clear and
convincing evidence that M.A.A. was “substantially incapable” of applying his
understanding of the benefits, risks, and alternatives to Invega to his own mental
health condition. In Melanie L., our supreme court explained that “the phrase
‘substantially incapable’ means, to a considerable degree, a person lacks the

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No. 2024AP1589-FT

ability or capacity to apply an understanding of the advantages and disadvantages
of medication to his or her own condition.” Melanie L., 349 Wis. 2d 148, ¶70.
The court further explained that the phrase “applying an understanding” requires
proof that the person be able “to make a connection between an expressed
understanding of the benefits and risks of medication and the person’s own mental
illness.” Id., ¶71.

¶26 Here, the County met this burden by clear and convincing evidence,
as established by the testimony and reports of the evaluators. Dr. Taylor testified
that, although M.A.A. was able to express an understanding of the advantages and
disadvantages of and alternatives to taking Invega, he was substantially incapable
of applying that understanding to his mental illness because he was adamant that
he was not mentally ill, that he had been misdiagnosed as having a mental illness,
and that he was doing well without medication. M.A.A. maintained these beliefs
“despite the very, very clear advantages that [he] has had on medication.”
Dr. Taylor’s report reflected the same conclusion, stating that M.A.A. “denies he
has a mental illness and denies his mental illness has anything to do with … his
current hospitalization.” Dr. Lace also testified that M.A.A. denied having a
mental illness. As our supreme court has explained, “if a person cannot recognize
that he or she has a mental illness, logically the person cannot establish a
connection between his or her expressed understanding of the benefits and risks of
medication and the person’s own illness.” Id., ¶72. Accordingly, I reject
M.A.A.’s argument on this issue.

¶27 Lastly, M.A.A. argues that his testimony at the final hearing
undermines the circuit court’s written conclusion that M.A.A. was “substantially
incapable” of applying the risks, benefits, and alternatives to Invega to his own
mental illness. As noted, M.A.A. testified at the final hearing that he would prefer

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No. 2024AP1589-FT

Invega over Abilify because he was “used to” Invega. Additionally, M.A.A.
points to Drs. Taylor’s and Lace’s testimony when they each conceded that
M.A.A.’s ability to express a preference between medications would indicate a
recent improvement in M.A.A.’s mental illness.5

¶28 This argument fails because M.A.A.’s testimony did not undermine
the basis for the circuit court’s determination—i.e., that M.A.A. denied having a
mental illness. M.A.A.’s stated preference for Invega did not establish that he
recognized his mental illness or that he recognized that he was experiencing
symptoms of his mental illness. Although both evaluators stated that M.A.A.’s
ability to express a preference for a medication would be an “improvement” when
compared to his condition at the time of their evaluations, neither evaluator stated
that such an ability, without more, equates to an ability to apply the benefits, risks
and alternatives to Invega to his own mental illness so that M.A.A. could make an
informed decision. Thus, M.A.A.’s testimony did not undermine the court’s
determination, and I reject M.A.A.’s argument to the contrary.

¶29 In sum, the circuit court’s conclusion that, because of mental illness,
M.A.A. was substantially incapable of applying an understanding of the
advantages and disadvantages of and alternatives to Invega to his mental illness, in
order to make an informed choice about whether to accept or refuse the
medication, was not clearly erroneous and was supported by clear and convincing
evidence in the record.

5
At the time of the final hearing, an involuntary medication order had been issued at the
probable cause hearing ten days previous, and I assume that M.A.A. had been involuntarily
medicated for a period of time after this order and before the final hearing.

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No. 2024AP1589-FT

CONCLUSION

¶30 For the foregoing reasons, the involuntary medication order of the
circuit court is affirmed.

By the Court.—Order affirmed.

This opinion will not be published. See WIS. STAT.
RULE 809.23(1)(b)4.

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