IN RE: L.S.M. (2026)

¶1 Pursuant to Section I, Paragraph 3(c), Montana Supreme Court Internal Operating Rules, this case is decided by memorandum opinion and shall not be cited and does not serve as precedent. Its case title, cause number, and disposition shall be included in this Court's quarterly list of noncitable cases published in the Pacific Reporter and Montana Reports.

¶2 Appellant L.S.M. (L.S.M.) appeals the December 13, 2023 Involuntary Mental Health Commitment Order entered by the Fourth Judicial District Court, Missoula County, which committed her to the Montana State Hospital (MSH) in Warm Springs, Montana, for a period of 90 days. L.S.M. contends the District Court erroneously considered inadmissible hearsay evidence referenced in the professional person's testimony at the involuntary commitment hearing. We reverse.¹

¶3 On November 30, 2023, L.S.M. was taken to the emergency room in Missoula by a crisis team. L.S.M. had been living in a car. Upon arrival at the hospital, L.S.M. presented with frostbite, sepsis, malnutrition, cellulitis of the hand, and psychotic decompensation. L.S.M. periodically refused to take antibiotics for her infection as well as her prescribed psychiatric medications. Doctor Rocco Molinaro, MD, reported in a psychiatric prognosis note on December 4, 2023, that “[g]iven frequent refusal of scheduled psych meds, history of poor compliance, history of violent agitation, extreme low BMI, global executive dysfunction etc, the least restrictive treatment setting that is appropriate is the State Hospital, where scheduled IM medications can be administered to stabilize the patient's thought disorder.”

¶4 In past years, L.S.M. has repeatedly been brought to the hospital with a variety of medical issues, including rectal prolapse, methamphetamine use, and manic episodes. In a previous visit to the emergency room, L.S.M. “attempted to stab a[n] emergency room technician with a pen in triage.”

¶5 Following a psychiatric consultation on December 1, 2023, Doctor Christopher Hellekson, MD, diagnosed L.S.M. with Bipolar I disorder and concluded that L.S.M. “would likely benefit from sustained long-term institutionalization due to refractory nature of severe mental illness even when treated, poor insight, noncompliance, poor executive function, and inability to self-manage medical care for acute on chronic issues, often related to severe rectal prolapses.” The State filed a Renewed Petition for Commitment on December 5, 2023, based on Dr. Hellekson's diagnosis and suggestion.

¶6 The District Court entered an Order for Detention, Examination, and Treatment on December 5, 2023, ordering that L.S.M. “be evaluated, treated and detained at a crisis house[.]” That same day, the District Court appointed an attorney for L.S.M. and ordered that she be examined by a certified mental health professional. L.S.M. and her attorney appeared remotely from the MSH for the initial appearance before the District Court on December 5, 2023.

¶7 Mental health care professional Shannon McNabb (McNabb) evaluated L.S.M. on December 7, 2023, at which L.S.M.’s counsel was present. McNabb's report iterated L.S.M.’s psychiatric history, her recent visit to and response to medical treatment at the emergency room, and her mental status. As additional sources of information for her report, McNabb listed her review of L.S.M.’s records, a case consultation, and McNabb's professional observations. The report also stated that L.S.M. ended the interview prior to McNabb completing the evaluation. McNabb's report concluded that, “[b]ased on records reviewed, consultation with Nora Schillo, and Respondent's statements regarding her lack of knowledge about what medical issues she was recently hospitalized for, it was clear that Respondent continued to remain unable to meet her basic needs of health, safety, and housing due to a mental illness[,]” and recommended that L.S.M. be committed in the MSH for no more than 90 days.

¶8 A hearing was held before the District Court on December 7, 2023. L.S.M. again appeared remotely from the MSH. The State called McNabb as its sole witness. After the parties stipulated to McNabb testifying as a qualified expert witness, McNabb stated that her recommendation stemmed from her evaluation of L.S.M., the Renewed Petition for Commitment, L.S.M.’s medical records from the MSH, records from the Missoula Police Department, and a conversation with Nora Schillo, a provider at the MSH who attempted to meet with L.S.M. McNabb explained it was customary to rely on such information when making a recommendation for involuntary commitment.

¶9 McNabb went on to testify about L.S.M.’s condition upon arrival at the emergency room, including her diagnosis of frostbite and sepsis and her initial hesitancy to take antibiotics. McNabb testified that L.S.M. said her feet were doing better in the interview, “[b]ut when [she] had spoken with medical staff from the [MSH], they reported that [L.S.M.] had been unwilling to allow anyone to assess her condition of her feet or her hands.” L.S.M.’s counsel made a hearsay objection to the testimony and the following transpired:

Q. BY MR. SANDSTROM: So as part of those consultations, expert individuals in your field of expertise, do they -- do they rely on those consultations of other providers in coming to their opinion?

A. Yes, they do.

MR. FITZMAURICE: So again, Your Honor, I would object to the contents of any of those conversations as hearsay.

THE COURT: So to the extent that you've testified about specific, I guess, statements that this professional voiced, I will sustain the objection.

To the extent that you've informed us that there's no record of assessment with regard to her feet and hands, I'll permit that.

¶10 McNabb then testified that she recommended L.S.M. be involuntarily committed to the MSH due to her recent admission to the emergency room for both frostbite and sepsis, L.S.M.’s unwillingness to allow medical staff to treat her illnesses, her inability to articulate why she was admitted to the emergency room, and her inability to articulate a long-term course of action to treat her existing medical conditions. L.S.M.’s attorney again objected, stating that while M. R. Evid. 703 allows a medical professional to consider the statements of other professionals in forming an opinion, these statements cannot be used “as substantive evidence of the contents of the petition in terms of the inability to meet basic needs.” The District Court allowed McNabb to continue testifying, stating that it would “consider those statements along with other evidence to determine whether or not there's sufficient evidence to demonstrate her inability to care for herself.”

¶11 After the State rested, L.S.M.’s counsel moved to dismiss the petition, stating the State had failed to meet its burden of proving that L.S.M. was unable to meet her own basic needs due to a mental disorder. The District Court denied the motion and held that substantial evidence had been presented to prove that L.S.M. was unable to meet her basic needs due to bipolar disorder, stating:

I'll further find that she is substantially unable to care for herself. Based on the reports from her medical records, I will find that the information with regard to her medical condition is admissible based on a hearsay exception because of the, I guess, policies with regard to considering medical evidence to be reliable because it's provided for purposes of treatment for an individual.

I will find that the conditions that have been established in the record and testified to by Ms. McNabb as to sepsis and frostbite are exceptions to the hearsay rule.

¶12 On December 13, 2023, the District Court issued an Involuntary Mental Health Commitment Order, holding that L.S.M. was to be committed to the MSH for a period of 90 days. L.S.M. appeals.

¶13 We review evidentiary rulings for abuse of discretion. In re O.L.K., 2024 MT 202, ¶ 9, 418 Mont. 90, 555 P.3d 767. To the extent that the district court's ruling interprets an evidentiary rule or statute, we review de novo. In re O.L.K., ¶ 9. We review a district court's involuntary civil commitment order to determine whether the court's findings of fact are clearly erroneous and whether its conclusions of law are correct. In re C.K., 2017 MT 69, ¶ 10, 387 Mont. 127, 391 P.3d 735. “ ‘A finding of fact is clearly erroneous only if not supported by substantial credible evidence, the district court misapprehended the effect of the evidence, or we have a definite and firm conviction upon review of the record that the court otherwise erred.’ ” In re G.M., 2024 MT 49, ¶ 8, 415 Mont. 399, 544 P.3d 893 (quoting In re C.K., ¶ 10). Evidence is viewed in the light most favorable to the prevailing party when determining whether substantial credible evidence supports the district court's findings. In re O.L.K., ¶ 10.

¶14 In an involuntary commitment determination, the district court first considers whether the respondent suffers from a mental disorder and secondly determines whether the respondent requires commitment based on several potential grounds including “whether the respondent, because of a mental disorder, is substantially unable to provide for the respondent's own basic needs of food, clothing, shelter, health, or safety.” Section 53-21-126(1)(a), MCA; see In re O.L.K., ¶ 12. “The State has the burden of proving: (1) the existence and nature of the alleged mental disorder to a reasonable degree of medical certainty; (2) all pertinent ‘physical facts’ beyond a reasonable doubt; and (3) all other matters by clear and convincing evidence.” In re G.M., ¶ 11 (citing § 53-21-126(1)-(2), MCA).

¶15 “Subject to generally applicable rules of evidence as pertinent in each case, the professional person appointed pursuant to §§ 53-21-122(2) and -123, MCA (2021) ‘may testify as to the ultimate issue of whether the respondent is suffering from a mental disorder and requires commitment,’ but such ‘testimony is insufficient unless accompanied by evidence from the professional person or others,’ as pertinent here, that ‘because of a mental disorder’ the respondent ‘is substantially unable to provide for [his or her] own basic needs of food, clothing, shelter, health, or safety.’ ” In re G.M., ¶ 11 (quoting § 53-21-126(4)(a), MCA) (emphasis omitted).

¶16 L.S.M. argues “the District Court erred in considering the professional person's report as substantive evidence supporting the petition for commitment, because that report was inadmissible hearsay.” Without the inadmissible hearsay evidence, L.S.M. contends the State “failed to present sufficient non-hearsay evidence to support the District Court's conclusion that L.S.M.’s mental disorder caused her to be substantially unable to provide for her basic needs.”

¶17 In response, the State acknowledges the District Court improperly admitted the hearsay evidence under the exception provided in M. R. Evid. 803(4) as statements made for the purpose of medical diagnosis or treatment. However, the State contends the evidence was otherwise admissible and properly considered by the District Court under M. R. Evid. 703. Thus, the State argues that “there was sufficient evidence to support the [D]istrict [C]ourt's finding that, because of a mental disorder, L.S.M. was unable to care for her own basic needs of food, clothing, shelter, health, or safety.”

¶18 Hearsay is defined as “a statement, other than one made by the declarant while testifying at the trial or hearing, offered in evidence to prove the truth of the matter asserted[,]” and is generally inadmissible except as otherwise provided by statute or the Rules of Evidence. M. R. Evid. 801(c), 802. A hearsay statement is not admissible merely because it is contained in a professional person's report. Section 53-21-126(3), MCA. It is undisputed that Dr. Hellekson's report from the emergency room is hearsay offered to prove that L.S.M. was brought to the emergency room by a crisis team suffering from frostbite and sepsis, and that she intermittently refused to take medication and antibiotics for her illnesses. Additionally, statements made by Nora Schillo and other MSH staff are hearsay offered to prove that L.S.M. was unwilling to let medical staff assess her illnesses at the MSH. It is also undisputed that these hearsay statements do not fall within the exception provided in Rule 803(4) as statements made for the purpose of medical diagnosis or treatment and as the District Court incorrectly held.

¶19 Nonetheless, “evidence not admissible for one purpose may be admissible for another.” In re G.M., ¶ 13 (citing M. R. Evid. 105). Consequently, “a declarant's out of court statement offered for some relevant purpose other than to prove the truth of the matter asserted is, by definition, not hearsay and thus admissible as definitional non-hearsay.” In re G.M., ¶ 13 (citing M. R. Evid. 401-02, 801(c), and 802). Under M. R. Evid. 703, “[a]n expert may base their opinion on otherwise inadmissible evidence so long as the information is ‘of a type reasonably relied upon by experts in a particular field.’ ” In re O.L.K., ¶ 23 (quoting M. R. Evid. 703). “The expert may testify to otherwise inadmissible information, including statements of third parties, to the extent it is relevant to the basis of their opinion.” In re O.L.K., ¶ 23. However, “ ‘the sole purpose of admission of otherwise inadmissible hearsay under Rule 703 is to aid the finder of fact in assessing the credibility and reliability of the expert's opinion,’ not as ‘a conduit to admit otherwise inadmissible information as substantive evidence.’ ” In re O.L.K., ¶ 23 (quoting In re C.K., ¶ 21); see also In re G.M., ¶ 14 (quoting In re C.K., ¶¶ 18-21).

¶20 Here, while referring to L.S.M.’s diagnoses of frostbite and sepsis, her inconsistent acceptance of treatment, and her unwillingness to allow medical staff to assess her condition, the District Court stated that it would “consider those statements along with other evidence to determine whether or not there's sufficient evidence to demonstrate her inability to care for herself.” Such statements originated in reports from emergency room providers and MSH staff that did not testify at the December 7, 2023 commitment hearing and of which McNabb had no personal knowledge. Thus, the District Court considered L.S.M.’s emergency room medical records and statements made by Nora Schillo as substantive evidence when it was only permitted to consider such evidence to assess the credibility of McNabb's opinion. Even if the District Court had admitted the evidence under Rule 703 for credibility purposes only, it was still required to, upon objection, weigh the probative value of the evidence against the risk of unfair prejudice under M. R. Evid. 403. In re G.M., ¶ 14 (describing Rule 403 as a “critical safeguard” that protects against improper or unfair use or effect of hearsay evidence admitted under Rule 703). Accordingly, while McNabb permissibly testified to her report's contents as part of the basis of her opinion under Rule 703, the District Court could not use the statements referenced in her testimony as substantive evidence.

¶21 Thus, setting aside the improperly purposed hearsay evidence, we conclude the State did not present sufficient evidence to support a finding that, because of a mental disorder, L.S.M. is substantially unable to provide for her own basic needs of food, clothing, shelter, health, or safety. The State may prove that the respondent is substantially unable to provide for her own basic needs “based solely on the testimony of the court-appointed professional person provided, of course, that the professional person's testimony is admissible under the pertinent rules of evidence.” In re G.M., ¶ 13. However, McNabb's admissible and properly considered testimony here was not sufficient to satisfy the State's burden. Although L.S.M.’s own statements made to McNabb are admissible for their substance as non-hearsay under M. R. Evid. 801(d)(2), L.S.M. provided little information during the evaluation. In fact, McNabb primarily based her recommendation on things L.S.M. did not say, such as L.S.M.’s inability to articulate why she was admitted to the emergency room and her inability to articulate a long-term course of action to treat her existing medical conditions. While L.S.M. did tell McNabb that she had recently been living in a car, that she believes she suffers from a mental illness, that she was willingly taking her psychiatric medications, and that her feet were a little achy but getting better, L.S.M. prematurely terminated the interview before McNabb could complete her evaluation. Even viewing the evidence in a light most favorable to the State as the prevailing party, there is simply not enough admissible evidence to find that L.S.M. was substantially unable to provide for her own basic needs due to a mental disorder. Therefore, we hold the District Court erroneously ordered L.S.M. be involuntarily committed.

¶22 We have determined to decide this case pursuant to Section I, Paragraph 3(c) of our Internal Operating Rules, which provides for memorandum opinions. In the opinion of the Court, the case presents a question controlled by settled law or by the clear application of applicable standards of review.

¶23 Reversed.

FOOTNOTES

1.   L.S.M. also raises the issue of whether the District Court erroneously relied on her prior mental health treatment records without first making the required findings under § 53-21-190, MCA. Because we find the hearsay issue to be dispositive, we do not address this issue.

JIM RICE

We Concur: CORY J. SWANSON JAMES JEREMIAH SHEA KATHERINE M. BIDEGARAY INGRID GUSTAFSON