Opinion
24A-MH-413
08-22-2024
B.E., Appellant-Respondent v. St. Vincent Stress Center, Appellee-Petitioner
ATTORNEYS FOR APPELLANT Talisha R. Griffin Indianapolis, Indiana Timothy J. O'Connor Indianapolis, Indiana ATTORNEYS FOR APPELLEE Andrew B. Howk Matthew M. Schappa Ryan A. McDonald Indianapolis, Indiana
Pursuant to Ind. Appellate Rule 65(D), this Memorandum Decision is not binding precedent for any court and may be cited only for persuasive value or to establish res judicata, collateral estoppel, or law of the case.
Appeal from the Marion Superior Court Trial Court Cause No. 49D08-2401-MH-1076 The Honorable David Certo, Judge
ATTORNEYS FOR APPELLANT Talisha R. Griffin Indianapolis, Indiana Timothy J. O'Connor Indianapolis, Indiana
ATTORNEYS FOR APPELLEE Andrew B. Howk Matthew M. Schappa Ryan A. McDonald Indianapolis, Indiana
MEMORANDUM DECISION
Altice, Chief Judge
Case Summary
[¶1] B.E. appeals the trial court's order of temporary commitment, challenging the sufficiency of the evidence. B.E. maintains that the commitment order must be set aside because St. Vincent Stress Center (the Stress Center) failed to present clear and convincing evidence that she is mentally ill and gravely disabled.
[¶2] We affirm.
Facts and Procedural History
[¶3] Sixty-three-year-old B.E. and her husband, G.E., live in Indianapolis and have been married for twenty-six years. B.E. has a lengthy history of mental disorders, including insomnia and manic episodes, and has been treated at various mental health clinics over the years. On some of those occasions, clinic staff had to place B.E. in restraints.
[¶4] In early January 2024, B.E. was suffering from insomnia and had been sleepless for days. At some point, B.E. became agitated, yelled and screamed obscenities at G.E., and threw things around the house. B.E. also hit and kicked G.E., and told G.E. that she hated him. B.E. then poured water and tequila on G.E. In response, G.E. called 911. Responding officers arrived and transported B.E. to the Stress Center.
[¶5] B.E. was formally admitted to the Stress Center on January 8, 2024, where she was initially treated by psychiatrist, Dr. Erika Cornett. B.E. was diagnosed with "bipolar one disorder current episode manic, severe, with psychotic features." Transcript at 18. Thereafter, the Stress Center filed an Application for Emergency Detention (the Application), alleging that B.E. has a psychiatric disorder and was "dangerous to others" or "gravely disabled." Appellant's Appendix Vol II at 14. The Application asserted that involuntary detention was required so B.E. could receive "care and treatment" for her "psychiatric disorder." Id. It was alleged that B.E. was "physically aggressive [and] unable to make safe decisions . . . due to her mental illness." Id. at 15.
[¶6] The trial court issued an emergency detention order, and the Stress Center requested a hearing for B.E.'s temporary commitment that would be in effect for up to ninety days. An attached physician's statement in support of the Stress Center's request provided that B.E. was suffering from "bipolar disorder with a substantial impairment or an obvious deterioration of . . . judgment or behavior that results in [her] inability to function independently." Id. at 21. The statement further asserted that B.E. was "actively manic with psychosis, was unable to sleep, with paranoid and grandiose delusions." Id.
[¶7] During the commitment hearing that commenced on January 29, 2024, Dr. Carl Ratliff-the psychiatrist who had assumed the primary care of B.E.- testified that he visited B.E. several times at the Stress Center and confirmed the initial bipolar and manic psychosis diagnoses. Dr. Ratliff explained that B.E.'s illness was manifested in several ways, including irritability, refusal to take medication, decreased sleep, and grandiose presentation. Dr. Ratliff also testified that B.E.'s mental illness impaired her thought processes and, as a result, B.E. refused to take her medication and could not manage her diabetes and hypertension.
[¶8] The trial court also heard evidence that because B.E. was not taking her medications, she had to be transferred to the med-psych unit at the Stress Center because her extremely high blood glucose level resulted in an episode of hyperglycemia. Dr. Ratliff testified that B.E. "doesn't believe that she needs to take any form of psychiatric medication," and that she cannot exhibit proper judgment and reasoning necessary to function independently. Transcript at 19. Dr. Ratliff believed that B.E.'s lack of insight into her diagnosis was detrimental to treatment, and commitment was necessary so B.E. could receive medications and be properly treated for her psychiatric mood disorder, diabetes, and hypertension.
[¶9] The trial court questioned Dr. Ratliff concerning B.E.'s alleged grave disability:
THE COURT: Dr. Ratliff has
[B.E.] given you any explanation of why she's neglected her diabetes or hypertension care?
DR. RATLIFF: No.
THE COURT: And sir do you believe that ignoring those conditions is dangerous?
DR. RATLIFF: Dangerous, potentially leading to death.
THE COURT: Well, thank you sir, that clarifies things.Id. at 30.
[¶10] B.E. also testified at the hearing, contending that no one had "diagnosed [her] with anything." Id. at 39. B.E. claimed that she refused to take any medications because the drugs offered to her were "not recommended for people with high blood pressure . . . because it can raise your blood glucose." Id. at 40. B.E. further testified that she was probably hospitalized for hyperglycemia "because of [her] diet." Id.
[¶11] Following B.E.'s testimony, the trial court asked B.E. about prior psychiatric hospitalizations. While B.E. provided descriptions of those hospitalizations and mental health episodes, she blamed G.E., claiming that he "didn't like the fact that [she] was back home . . . and he dragged [her] out of the house . . . back to [the] Treatment Center...." Id. at 44.
[¶12] Following the hearing, the trial court entered an order of temporary commitment on January 29, 2024, concluding that B.E. is gravely disabled and is in need of "custody, care, and treatment at [the Stress Center] for a period of time not to exceed ninety . . . days. Appellant's Appendix Vol. II at 11. B.E. was also ordered to take medications as prescribed, attend all scheduled clinic sessions, and not "to harass or assault family members or others." Id. at 12.
At first blush, B.E.'s appeal appears moot because the temporary commitment order expired before briefing was completed. Generally, a case is considered moot when no effective relief can be rendered to the parties on appeal. Matter of Lawrance, 579 N.E.2d 32, 37 (Ind. 1991). As B.E. points out, however, this court may consider an appeal from an involuntary commitment even though the term of commitment has expired because "leaving the judgment undisturbed might lead to negative collateral consequences." C.P. v. St. Vincent Hosp. and Health Care, Ctr., Inc., 219 N.E.3d 142, 147 (Ind.Ct.App. 2023). In the context of an involuntary commitment, a history of mental illness requiring hospitalizations may be probative of whether a person is "gravely disabled and should be involuntarily committed." Golub v. Giles, 814 N.E.2d 1034, 1039 (Ind.Ct.App. 2004), trans. denied. It follows, therefore, that once a patient is adjudicated as gravely disabled and is involuntarily committed, the petitioner's burden in subsequent commitment proceedings is significantly reduced. Additionally, the commitment order prevents B.E. from exercising her constitutional right to keep and bear a firearm, as 18 U.S.C §§ 922 (g)(4), 924 (a)(8) prohibits an individual who has been committed to a mental institution from knowingly possessing a firearm, the violation of which may result in a fifteen-year sentence. Similarly, Ind. Code § 35-47-2-1.5 (a)(3)(B), (b)(7)(C), (e) prohibits a person who has been involuntarily committed from knowingly or intentionally carrying a handgun. In light of these potential collateral negative consequences of the commitment order, we decline to dismiss B.E.'s appeal on the grounds of mootness and will address her appeal on the merits. See C.P., 219 N.E.2d at 149.
Discussion and Decision
I. Standard of Review
[¶14] On an appeal from an order for commitment, this court neither reweighs the evidence nor rejudges the credibility of witnesses. In re Commitment of T.K., 27 N.E.3d 271, 274 (Ind. 2015). Rather, we "consider only the evidence most favorable to the trial court's judgment and all reasonable inferences drawn therefrom." In the Matter of the Civ. Commitment of W.S. v. Eskenazi Health, Midtown Cmty. Mental Health, 23 N.E.3d 29, 33 (Ind.Ct.App. 2014), trans. denied. An order for commitment will be affirmed if "a reasonable trier of fact could find the necessary elements proven by clear and convincing evidence." T.K., 27 N.E.3d at 273.
[¶15] In accordance with Ind. Code § 12-26-2-5(e), the trial court's civil commitment order will be upheld when it is supported by clear and convincing evidence that:
1. The individual was mentally ill;
2. The individual was either dangerous or gravely disabled; and
3. The commitment was appropriate.
II. B.E.'s Contentions
A. Mental Illness
[¶16] B.E. claims that the commitment order must be set aside because the evidence failed to establish that she suffered from a mental illness. B.E. contends that her own testimony belied that diagnosis and her symptoms "were not necessarily indicative of mental illness." Appellant's Brief at 19.
[¶17] As defined in Ind. Code § 12-7-2-130, mental illness is a psychiatric disorder that "(A) substantially disturbs an individual's thinking, feeling, or behavior; and (B) impairs the individual's ability to function." Bipolar disorder falls within the term "mental illness." In re Involuntary Commitment of A.M., 959 N.E.2d 832, 835 (Ind.Ct.App. 2011).
[¶18] At the temporary commitment hearing, Dr. Ratliff confirmed the initial diagnosis that B.E. suffered from bipolar disorder. Dr. Ratliff pointed to B.E.'s irritability, her inability to sleep longer than "two to maybe five hours per night," and her "over-inflated sense of self with grandios[ity] in her presentation." Transcript at 17, 18. Dr. Ratliff also explained that the diagnosis was based on B.E.'s altered thought process:
In terms of her thought process, it tends to perseverate about two topics, either her husband or her lack of need to take medications and her insight and judgment regarding her illness is limited to poor and also her compliance to take medication has been poor for both psychiatric medications and her medications for her diabetes and hypertension.Id. at 19.
[¶19] Dr. Ratliff's testimony established that B.E. had a substantially disturbed thought process that caused her to become irritable-a key criterion for finding the existence of a mental illness. See I.C. § 12-7-2-130. Moreover, B.E.'s sleep deprivation-coupled with the inability to manage her underlying health conditions-affected B.E.'s ability to function. Dr. Ratliff also discounted B.E.'s testimony that she was irritable because of her relationship with G.E. and opined that B.E.'s aggression and sleeplessness were caused by her mania.
[¶20] As we refuse to reweigh the evidence, we conclude that the Stress Center's evidence-namely Dr. Ratliff's testimony-readily supported the trial court's conclusion that B.E. suffered from a mental illness. See, e.g., In re Commitment of M.M. v. Clarian Health Partners, 826 N.E.2d 90, 97 (Ind.Ct.App. App. 2005) (the trial court properly concluded that M.M. suffered from a mental illness based on the treating physician's testimony that M.M. was erratic, irritable, and angry, lacked insight into her diagnosis, exercised poor judgment, and refused to take medication), trans. denied.
B. Gravely Disabled
[¶21] B.E. also claims that the trial court erred in determining that she was gravely disabled. B.E. asserts that the Stress Center failed to present any evidence that she was "unable to provide for her basic needs." Appellant's Brief at 21.
[¶22] I.C. § 12-7-2-96 defines "gravely disabled" as a "condition in which an individual, as a result of mental illness, is in danger of coming to harm because the individual:
(1) is unable to provide for that individual's food, clothing, shelter, or other essential human needs; or
(2) has a substantial impairment or an obvious deterioration of that individual's judgment, reasoning, or behavior that results in the individual's inability to function independently.
[¶23] As we have often observed, because this statute is written in the disjunctive, a trial court's finding of grave disability survives if we find that there was sufficient evidence to prove either that the individual is unable to provide for her basic needs or that her judgment, reasoning, or behavior is so impaired or deteriorated that it results in her inability to function independently. See T.A. v. Wishard Health Servs., 950 N.E.2d 1266, 1271 n.2 (Ind.Ct.App. 2011).
[¶24] In this case, Dr. Ratliff testified that B.E. suffered from "severe issues" related to her diabetes and anti-hypertensive management while at the Stress Center. Transcript at 20. B.E. refused to take her insulin, thus requiring the Stress Center to transport her to the med-psych unit. And B.E.'s refusal to address her diabetes caused her to become hyperglycemic.
[¶25] The trial court asked Dr. Ratliff whether B.E. had explained why she neglected her diabetes and hypertension conditions and care. Dr. Ratliff responded "no" and stated that ignoring these conditions was "dangerous," and could "lead to [B.E.'s] death." Transcript at 30. When Dr. Ratliff was questioned about why commitment was appropriate for B.E., he testified that he did not think B.E. could currently manage any of her underlying health conditions and explained that
I think once stabilized with medications and getting her blood sugars regulated in which she will comply with medications of the accu-checks and her diabetic care, her diabetes meds as well as her antihypertensives, I think she can be managed on an outpatient basis. But I think at this point right now, um, I have very limited um hope that she would remain compliant with the medications based on her performance here in a structured setting of the Stress Center.Transcript at 24.
[¶26] The foregoing evidence clearly and convincingly demonstrates that B.E. is in danger of coming to harm because she has a substantial impairment of her judgment, reasoning, and behavior that has resulted in her inability to function independently. See, e.g., J.S. v. Ctr. for Behavioral Health, 846 N.E.2d 1106, 1113 (Ind.Ct.App. 2006) (evidence supported finding that mental health patient would be gravely disabled if she stopped taking her medications), trans. denied.
[¶27] For all these reasons, we conclude that B.E.'s temporary commitment is supported by sufficient evidence.
[¶28] Judgment affirmed.
Bailey, J. and Mathias, J., concur.