Opinion
24A-MH-713
12-19-2024
In the Matter of the Civil Commitment of N.H., Appellant-Respondent v. Community Health Network, Inc., Appellee-Petitioner
ATTORNEYS FOR APPELLANT Talisha Griffin Ellen M. O'Connor Marion County Public Defender Agency Indianapolis ATTORNEYS FOR APPELLEE Jenny R. Bucharest Sean T. Dewey Ice Miller LLP Indianapolis
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 Appellate Rule 65(D), this Memorandum Decision is not binding precedent for any court and may be cited only for persuasive value or to establish res judicata, collateral estoppel, or law of the case.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 The Honorable David Certo, Judge The Honorable Sarah Glasser, Magistrate Trial Court Cause No. 49D08-2403-MH-9546
ATTORNEYS FOR APPELLANT Talisha Griffin Ellen M. O'Connor Marion County Public Defender Agency Indianapolis
ATTORNEYS FOR APPELLEE Jenny R. Bucharest Sean T. Dewey Ice Miller LLP Indianapolis
MEMORANDUM DECISION
Pyle, Judge
Statement of the Case
[¶1] N.H. ("N.H.") appeals her temporary involuntary civil commitment to the Community Health Network ("the hospital") for her treatment of mental illness. Although she has been released, she claims that her appeal is not moot because she will suffer collateral consequences from the commitment order. She argues that: (1) her appeal is not moot under the collateral consequences doctrine; and (2) there was insufficient evidence supporting her commitment order. Concluding that her appeal is not moot and that there was sufficient evidence supporting her temporary involuntary civil commitment, we affirm the trial court's commitment order.
[¶2] We affirm.
Issues
1. Whether N.H.'s appeal is moot.
2. Whether there was sufficient evidence supporting N.H.'s temporary involuntary civil commitment.
Facts
[¶3] In early 2024, twenty-four-year-old N.H. began living with her father C.H. ("C.H."). N.H. was serving time on home detention from her sentence in a criminal case. At that time, N.H., who has three children, had an open case with the Department of Child Services ("DCS"), and her children were not living with her.
[¶4] About one or two weeks after she began living with C.H., N.H. began telling C.H. that "she was going to kill herself." (Tr. Vol. 2 at 7). N.H. also made "statements about suicide" and "wanting to hurt herself." (Tr. Vol. 2 at 7). A couple of days later, on March 4, 2024, N.H. overdosed on drugs. C.H. came home and found N.H. "half dead." (Tr. Vol. 2 at 6). N.H. "wasn't breathing," and C.H. performed CPR on her and called an ambulance. (Tr. Vol. 2 at 6). N.H. was transported to the hospital.
[¶5] On March 12, 2024, the hospital filed with the trial court a petition for a commitment hearing. In its petition, the hospital alleged that N.H. suffered from an unspecified depressive disorder and an opioid use disorder. On March 19, 2024, the trial court held a hearing. At the hearing, Community Health Network Psychiatrist Kanwaldeep Sidhu ("Dr. Sidhu") testified that he had examined N.H. "[a]bout nine times" including the morning of the hearing. (Tr. Vol. 2 at 13). Dr. Sidhu also testified that N.H. was diagnosed with unspecified depressive disorder and opioid use disorder. Dr. Sidhu testified that the hospital "continue[d] to have concerns about . . . [N.H.'s] safety and her cognitive condition." (Tr. Vol. 2 at 13). Dr. Sidhu further testified that N.H. was "at high risk of harm to herself" and had "issues with memory loss and cognitive issues[.]" (Tr. Vol. 2 at 13). Dr. Sidhu testified that N.H.'s unspecified depressive disorder diagnosis was due to her "complex history" of "contributing factors to her depression[,]" which included drug use, social issues related to not having custody or being able to see her children, and her legal issues. (Tr. Vol. 2 at 14). Dr. Sidhu further testified that N.H. needed to become sober before the hospital could give N.H. a "diagnosis of either major depression or . . . something similar[.]" (Tr. Vol. 2 at 14).
[¶6] Dr. Sidhu testified that N.H.'s memory problems were likely due to her "hypoxia of the brain" from her overdose and being found unresponsive. (Tr. Vol. 2 at 14). Dr. Sidhu explained that N.H. presented "short-term memory issues[,]" which caused her to struggle to remember something from twenty or thirty minutes earlier or something from the previous day. (Tr. Vol. 2 at 15). Dr. Sidhu further testified that he had conducted a mini mental state exam on N.H., and N.H. had scored similarly to someone with "early dementia" or "mild cognitive disorder[.]" (Tr. Vol. 2 at 15). Dr. Sidhu further testified that he believed that N.H. had "poor judgment" and "poor impulse control." (Tr. Vol. 2 at 18). Dr. Sidhu also testified that N.H.'s drug screen, which she submitted when she had been admitted to the hospital, revealed that N.H. had "benzodiazepine and cocaine in her system." (Tr. Vol. 2 at 15). Dr. Sidhu testified that N.H.'s drug screen did not reveal any opiates, but that N.H. "likely overdose[d] on Fentanyl which doesn't show up on the urine drug screen." (Tr. Vol. 2 at 15).
[¶7] Dr. Sidhu also testified that, while hospitalized, N.H. was taking medication "to reduce her cravings for opiates[.]" (Tr. Vol. 2 at 16). Dr. Sidhu further testified that the hospital was "a very structured environment" because it is a "locked facility" where N.H. is given her medicine and meals. (Tr. Vol. 2 at 16). Dr. Sidhu testified that he was concerned that N.H., if released from the hospital, had the potential for relapse and overdose. Dr. Sidhu testified that N.H. may not remember to take her medicine or follow up with appointments, and he recommended that "professionals . . . monitor her . . . until the memory loss is more clear." (Tr. Vol. 2 at 17). Dr. Sidhu also testified that if a person uses other opiates with the medicine used for opiate cravings, "the interaction isn't very pleasant and [a person] c[ould] have withdraw[al] and . . . potentially overdose[.]" (Tr. Vol. 2 at 17). Dr. Sidhu explained that N.H. was currently taking Buprenorphine, Lexapro for anxiety and depression, Buspirone for anxiety, and Depakote, which "helps with mood and anxiety and helps reduce any chances of any seizures or withdrawal." (Tr. Vol. 2 at 20).
[¶8] When the hospital's counsel asked Dr. Sidhu if he believed that N.H. was gravely disabled, he responded, "I think so." (Tr. Vol. 2 at 18). Additionally, when the hospital's counsel asked Dr. Sidhu if he believed that N.H. was a substantial risk to herself or others, Dr. Sidhu responded, "[y]eah, there's a potential for another overdose[.]" (Tr. Vol. 2 at 18). When the hospital's counsel asked Dr. Sidhu if N.H. "ha[d] any substantial impairment or deterioration in her judgment, reasoning[,] and behavior that impact[ed] her ability to function independently[,]" Dr. Sidhu responded, "[y]eah, . . . because of the memory loss and confusion[,] [her] judgement is not that great." (Tr. Vol. 2 at 17). The hospital's counsel asked Dr. Sidhu if N.H., without the structure and prompting that she receives at the hospital, would be able to engage in more complex activities "such as managing her finances, making medical decisions[,] or seeking appointments[]." (Tr. Vol. 2 at 17). Dr. Sidhu responded that he believed that "it would be very hard for [N.H.] to do that" with her memory loss. (Tr. Vol. 2 at 17). Dr. Sidhu requested that the trial court grant the hospital's petition for a temporary involuntary commitment because it would give the hospital or an outpatient team the opportunity to engage N.H. with services and would provide time for N.H.'s memory loss to get better.
[¶9] C.H. also testified at the hearing. C.H. testified that N.H. needed reminders about when to eat and sleep. C.H. also testified that N.H. was suffering from "a lot of depression" because she did not have her kids. (Tr. Vol. 2 at 10). N.H., who was twenty-four years old, testified that she had been a mother since she was fourteen years old. N.H. testified that her children were living with her sister. When N.H.'s counsel asked N.H. if DCS was involved in her family life, N.H. responded, "Yes[.]" (Tr. Vol. 2 at 32). N.H. further testified that she had an active child in need of services ("CHINS") case with her youngest son. N.H. further testified that going from "a full-time mom to losing [her] children" had "been really hard[.]" (Tr. Vol. 2 at 32). N.H. also testified that she did not want to commit suicide or hurt herself, but she admitted that she did have a drug use problem. N.H. also testified that she was "just more of a partyer" with drugs and was a "dibble dabble type of person[.]" (Tr. Vol. 2 at 34).
[¶10] At the conclusion of the hearing, the trial court found that N.H. suffered from unspecified depressive disorder and opioid use disorder. The trial court also found that N.H. was a danger to herself and was gravely disabled. The trial court also noted that it did not find N.H.'s testimony to be credible. The trial court ordered that N.H. be committed to the hospital for a period not to exceed ninety days.
[¶11] N.H. now appeals. Decision
[¶12] N.H. challenges the sufficiency of the evidence supporting her temporary involuntary civil commitment. However, N.H. acknowledges that her involuntary temporary civil commitment has expired. N.H. argues that: (1) her appeal is not moot under the collateral consequences doctrine; and (2) there was insufficient evidence supporting her commitment order. We address each of her arguments in turn.
1. Mootness
[¶13] N.H. acknowledges that her involuntary temporary civil commitment has expired. However, she contends that her appeal is not moot. "A case is moot when the controversy at issue has been ended, settled, or otherwise disposed of so that the court can give the parties no effective relief." E.F. v. St. Vincent Hosp. &Health Care Ctr., Inc., 188 N.E.3d 464, 466 (Ind. 2022). A moot appeal is subject to dismissal because the opinion is merely advisory if effective relief cannot be granted. C.P. v. St. Vincent Hosp. &Health Care Ctr., Inc., 219 N.E.3d 142, 146-147 (Ind.Ct.App. 2023).
[¶14] N.H. argues that her appeal is not moot because she will suffer harmful collateral consequences absent appellate review of her involuntary temporary civil commitment. An appeal may be heard when significant negative collateral consequences will result if the judgment stands. Id. at 147. "Indiana's appellate courts have applied the 'collateral consequences' doctrine to hold that appeals are not moot where meaningful relief may still be had by our review of those appeals on their merits." Id.
[¶15] N.H. argues that "appellate review must be available" because her involuntary civil commitment has a collateral consequence in her DCS case. (N.H.'s Br. 18). Specifically, N.H. alleges that the commitment order could have consequences related to N.H.'s custody of and reunification with her children. In response, the hospital argues that N.H. has failed to present a cogent argument or point to any evidence in the record establishing that her temporary commitment has collateral consequences. Our Court has already discussed the negative consequences of a CHINS determination, noting that any such determination "could result in adverse job consequences or preclude a parent from serving as a foster parent in the future." Matter of A.T., 219 N.E.3d 90, 98 (Ind.Ct.App. 2023). See also In re S.D., 2 N.E.3d 1283, 1290 (Ind. 2014).
Further, a CHINS determination can have "serious consequences for families" because two separate CHINS adjudications "can be the basis for a petition to terminate parental rights." Matter of N.C. , 72 N.E.3d 519, 524 (Ind.Ct.App. 2017). Because the existence of N.H.'s DCS case is properly presented in the record and because there is a clear collateral consequence flowing from her temporary involuntary civil commitment, we exercise our discretion to review the merits of N.H.'s commitment order. See C.P., 219 N.E.3d at 149 (holding that appellate review of an expired commitment order was not moot where the individual would face the collateral consequence of the loss of his right to lawfully possess a handgun where the record was clear that the individual had exercised that right since he had been eighteen). See also A.B. v. St. Vincent Hosp. and Health Care Ctr., Inc., 240 N.E.3d 166, 169 (Ind.Ct.App. 2024) (holding that the appeal of an expired commitment order was not moot where there were collateral consequences that were likely to occur because the individual possessed a registered behavior technician certification that required her to report "mental health hospitalizations that impact her ability to provide services").
2. Sufficiency
[¶16] N.H. also argues that there was insufficient evidence supporting the trial court's involuntary temporary commitment order. The purpose of civil commitment proceedings is to protect the public and to ensure the rights of the person whose liberty is at stake. Civil Commitment of T.K. v. Dep't of Veterans Affairs, 27 N.E.3d 271, 273 (Ind. 2015). Given the liberty interest at stake, the serious stigma involved, and the adverse social consequences that accompany such physical confinement, a proceeding for an involuntary civil commitment is subject to due process requirements. Id. In order to protect the due process rights of a person subject to commitment, the facts justifying an involuntary commitment must be shown by clear and convincing evidence. Id. This standard of proof "communicates the relative importance our legal system attaches to a decision ordering an involuntary commitment," and it has the function of reducing the likelihood of inappropriate commitments. Id. (internal quotation marks and citation omitted). When we review the sufficiency of the evidence supporting an involuntary civil commitment, we will affirm if, after considering the probative evidence and reasonable inferences supporting the decision, a reasonable trier of fact could have found the necessary elements proven by clear and convincing evidence. Id. We do not reweigh the evidence, nor do we judge witness credibility. Id.
[¶17] To obtain an involuntary commitment, a petitioner is "required to prove by clear and convincing evidence that: (1) the individual is mentally ill and either dangerous or gravely disabled; and (2) detention or commitment of that individual is appropriate." IND. CODE § 12-26-2-5(e) (format altered). Thus, here, the Hospital had the burden of proving subsections (1) and (2) by clear and convincing evidence.
[¶18] N.H. does not dispute the sufficiency of the evidence supporting the elements that she is mentally ill and that the commitment is appropriate. Instead, she challenges the "dangerous" or "gravely disabled" elements. Specifically, N.H. contends that the hospital failed to present clear and convincing evidence that she was dangerous to herself and that she was gravely disabled.
[¶19] However, "[i]t is important to note that in order to carry its burden of proof, [the hospital] only had to prove that [N.H.] was either gravely disabled or dangerous. It did not have to prove both of these elements." M.Z. v. Clarian Health Partners, 829 N.E.2d 634, 637 (Ind.Ct.App. 2005) (emphasis in original), trans. denied. Accordingly, we will address only the gravely disabled element.
[¶20] Gravely disabled is defined 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 humans 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.IND. CODE § 12-7-2-96. Because the definition of grave disability is written in the disjunctive, the evidence needs to support only one of those two prongs for a person to be found gravely disabled. See Civil Commitment of W.S. v. Eskenazi Health, Midtown Cmty. Health, 23 N.E.3d 29, 34 (Ind.Ct.App. 2014) (explaining that a trial court's finding of grave disability survives if we find that there was sufficient evidence to prove either that the individual was unable to provide for his basic needs or that his judgment, reasoning, or behavior is so impaired or deteriorated that it results in his inability to function independently), trans. denied.
[¶21] Here, during the temporary commitment hearing, the hospital met its burden of proving the involuntary commitment elements through the testimony of Dr. Sidhu, who testified, among other things, that N.H. has a substantial impairment or an obvious deterioration of her judgment, reasoning, or behavior that results in her inability to function independently. Specifically, Dr. Sidhu gave lengthy testimony regarding N.H.'s memory problems due to her drug overdose. Dr. Sidhu testified that N.H.'s memory problems were likely due to her "hypoxia of the brain" from her overdose and being found unresponsive. (Tr. Vol. 2 at 14). Dr. Sidhu also testified that N.H. had short-term memory problems, which included difficulty remembering something that had happened twenty or thirty minutes earlier as well as something that had happened the previous day. Dr. Sidhu compared N.H.'s memory impairment to a person who was in the early stages of dementia.
[¶22] Further, Dr. Sidhu testified that the hospital was "a very structured environment" because it is a "locked facility" where N.H. is given her medicine and meals. (Tr. Vol. 2 at 16). Dr. Sidhu testified that he was concerned that N.H., if released from the hospital, had the potential for relapse and overdose. Dr. Sidhu also testified that, because of N.H.'s memory problems, she would have trouble with engaging in more complex activities such as managing her finances, making medical decisions, or seeking appointments.
[¶23] In light of the clear and convincing evidence that N.H. was gravely disabled, we conclude that the trial court did not err by ordering N.H.'s involuntary temporary civil commitment at the hospital. N.H.'s argument is nothing more than a request to reweigh the evidence, which we will not do. T.K., 27 N.E.3d at 273. We affirm the trial court's involuntary temporary commitment order.
[¶24] Affirmed.
Weissmann, J., and Felix, J., concur.