Opinion
24A-MH-1485
12-18-2024
In re: the Civil Commitment of: C.R., Appellant-Respondent v. Indiana University Health-Bloomington Hospital, Appellee-Petitioner
Attorney for Appellant Stuart K. Baggerly Bloomington, Indiana Attorneys for Appellee Kathryn E. DeWeese Joshua L. Radicke Bunger & Robertson Bloomington, 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 Appellate Rule 65(D), this Memorandum Decision is not binding precedent for any court and may be cited only for persuasive value or to establish res judicata, collateral estoppel, or law of the case.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 Monroe County Circuit Court The Honorable Kara E. Krothe, Judge Trial Court Cause No. 53C06-2405-MH-000230
Attorney for Appellant Stuart K. Baggerly Bloomington, Indiana
Attorneys for Appellee Kathryn E. DeWeese Joshua L. Radicke Bunger & Robertson Bloomington, Indiana
MEMORANDUM DECISION
DEBOER, JUDGE
Case Summary
[¶1] C.R. appeals his involuntary commitment to a state psychiatric hospital and presents a single issue for review, which we restate as whether Indiana University Health Bloomington Hospital ("IU Health") presented sufficient evidence to prove C.R. is either dangerous to himself or others or is gravely disabled. We affirm.
Facts and Procedural History
[¶2] C.R. is a fifty-eight-year-old homeless man who struggles with schizophrenia. Between October 2023 and May 2024, C.R. was hospitalized for psychiatric reasons on four occasions, three of which occurred within the prior one and one-half months. Appellant's App. 2 at 17. C.R. had also been to the emergency room at least ten times within the past five months for a variety of reasons. Tr. Vol. 2 at 6. When C.R. most recently went to IU Health for treatment, he experienced "suicidal ideations, homicidal ideations, and command hallucinations." Appellant's App. 2 at 17. Dr. David Duncan examined C.R. and testified that C.R. made disorganized remarks, such as wanting to get out to "hurt his vape pen," wishing "he was never born," and that his "life sucks." Id. at 19. C.R. also "endorse[d] homicidal ideation" and stated, "China is going to kill us all" before discussing a "yellow submarine." Id. Dr. Duncan's treatment notes indicated, C.R. "continues to meet criteria for inpatient psychiatric hospitalization as [C.R.] is unable to function safely in a lesser restrictive environment at this time. [C.R.] requires continued inpatient hospitalization for mood stabilization, medication titration, and clinical improvement." Appellant's App. 2 at 30.
Dr. Duncan, an IU Health psychiatrist, initially examined C.R. between May 17, 2024 and May 20, 2024. Then from May 21, 2024 through the date of the hearing on May 23, 2024, another IU Health psychiatrist, Dr. Eric Monsebias treated C.R.
[¶3] IU Health sought an involuntary commitment order. At the hearing on IU Health's petition, Dr. Eric Monsebias testified that C.R. often comes to the hospital dehydrated, with "bodily injuries," and "has fairly poor insight into his illness." Tr. at 6. C.R. had "started to calm down since he got back on his medication," but Dr. Monsebias expressed concern that after past hospitalizations, C.R. "stopped taking his medications multiple times." Id. at 5. Dr. Monsebias mentioned that after C.R.'s most recent discharge from the hospital, he was "going off his meds again." Id. at 6. Dr. Monsebias did not believe C.R. "currently" poses a danger to himself or others but endorsed the idea that C.R. is "at times an unintentional danger to himself." Id. at 7. Dr. Monsebias recommended "extended treatment" with C.R. committed to "a state hospital for [] a few months to . . . pursue further stabilization." Id. at 8. IU Health also requested a forced medication order if C.R. refuses to take oral medication.
[¶4] The trial court found that C.R. was mentally ill, dangerous to himself, gravely disabled, and in need of commitment to an appropriate facility for a period expected to exceed 90 days, along with medicated treatment.
Discussion and Decision
[¶5] C.R. contends that IU Health did not justify his commitment by presenting clear and convincing evidence he was either dangerous or gravely disabled. We address each of these factors in turn.
[¶6] Our Indiana Supreme Court has explained Indiana's laws regarding civil commitment:
In Indiana, an adult person may be civilly committed either voluntarily or involuntarily. Involuntary civil commitment may occur under [some] circumstances if certain statutorily regulated conditions are satisfied: . . . []"Emergency Detention" for up to 72 hours, see Ind. Code § 12-26-5 et seq.; [] "Temporary Commitment" for up to 90 days, see Ind. Code § 12-26-6 et seq.; and [] "Regular Commitment" for an indefinite period of time that may exceed 90 days, see Ind. Code § 12-26-7 et seq.Civ. Commitment of T.K. v. Dep't. of Veterans Affairs, 27 N.E.3d 271, 273 n.1 (Ind. 2015).
The purpose of civil commitment proceedings is dual: to protect the public and to ensure the rights of the person whose liberty is at stake. Id. at 273. "The liberty interest at stake in a civil commitment proceeding goes beyond a loss of one's physical freedom, and given the serious stigma and adverse social consequences that accompany such physical confinement, a proceeding for an involuntary civil commitment is subject to due process requirements." Id. This helps to minimize the risk of erroneous decisions from the Court. See Addington v. Texas, 441 U.S. 418, 425-26, 99 S.Ct. 1804, 1809 (1979).
[¶7] To obtain an involuntary regular commitment of an individual, 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). Clear and convincing evidence is an "intermediate standard of proof greater than a preponderance of the evidence and less than proof beyond a reasonable doubt." T.D. v. Eskanazi Midtown Cmty. Mental Health Ctr., 40 N.E.3d 507, 510 (Ind.Ct.App. 2015) (quoting Lazarus Dep't Store v. Sutherlin, 544 N.E.2d 513, 527 (Ind.Ct.App. 1989)). When reviewing the sufficiency of the evidence supporting a civil commitment, "an appellate court will affirm if, 'considering only the probative evidence and the reasonable inferences supporting it, without weighing evidence or assessing witness credibility, a reasonable trier of fact could find [the necessary elements] proven by clear and convincing evidence.'" T.K., 27 N.E.3d at 273 (citing Bud Wolf Chevrolet, Inc. v. Robertson, 519 N.E.2d 135, 137 (Ind. 1988)).
Because the statute is written in the disjunctive, a petitioner need only prove the respondent is gravely disabled or dangerous, not both. A.S. v. Indiana University Health Bloomington Hospital, 148 N.E.3d 1135, 1140 (Ind.Ct.App. 2020).
1. Mentally Ill
[¶8] Mental illness, for the purposes of regular civil commitment, refers to "a psychiatric disorder that substantially disturbs an individual's thinking, feeling, or behavior and impairs the individual's ability to function." Ind. Code § 12-72-130(1). The trial court found that C.R. suffers from schizophrenia, which it found is a "mental illness" as defined by Indiana Code § 12-7-2-130(1). Appellant's App. 2 at 5. This finding was not challenged on appeal. Dr. Monsebias testified that C.R. had "been diagnosed with schizophrenia," with symptoms including hallucinations, paranoia and "disorganized behavior." Id. Given Dr. Monsebias's testimony about C.R.'s symptoms and diagnosis, and the fact that C.R. does not challenge the trial court's findings of mental illness on appeal, we will not disturb the trial court's finding of mental illness.
2. Dangerousness
[¶9] "Dangerous" is defined as "a condition in which an individual as a result of mental illness, presents a substantial risk that the individual will harm the individual or others." I.C. § 12-7-2-53(a). This condition "must be shown by clear and convincing evidence indicating that the behavior used as an index of a person's dangerousness would not occur but for the person's mental illness." Commitment of M.M. v. Clarian Health Partners, 826 N.E.2d 90, 97 (Ind.Ct.App. 2005), trans. denied.
[¶10] The record reflects C.R. was dangerous to himself as a result of his mental illness. C.R. arrived at the hospital while off his medications, exhibiting symptoms of schizophrenia, and was "clearly disorganized, having some auditory hallucinations, paranoia, disorganized behavior [] some even aggressive," Tr. at 5, and "making homicidal statements." Id. at 7. Dr. Monsebias testified that C.R.'s behaviors are consistent with his schizophrenia diagnosis. Although Dr. Monsebias testified C.R. is "not currently" a danger to himself or other persons, C.R. only began to "calm down" when he became medicated upon arrival at the hospital. Tr. at 5, 7. A trial court is not required to wait until harm has nearly or actually occurred before determining that an individual is dangerous to himself or others. A.P. v. Comm. Health Network, Inc., 238 N.E.3d 704, 710 (Ind.Ct.App. 2024) (citing C.J. v. Health and Hosp. Corp. of Marion Cty., 842 N.E.2d 407, 410 (Ind.Ct.App. 2006)). C.R. was placed on medication during previous hospitalizations but goes off his medications frequently, including in May 2024 when he returned to the hospital exhibiting "aggressive behavior toward others." Appellant's App. 2 at 23. C.R.'s failure to take his medications historically leads to him intentionally and recklessly harming himself. Id. at 8. When he arrived at the hospital, C.R. made comments wishing he had never been born. See A.P., 238 N.E.3d at 709-10 (finding clear and convincing evidence of dangerousness to self where A.P. made "veiled suicide comments," stated he didn't "want to live like this," and often drifted "into discussion about how he doesn't want to be alive"). See also C.J., 842 N.E.2d at 410 (finding clear and convincing evidence of dangerousness to others where C.J. threatened staff, struck another patient, and threatened self-harm). C.R.'s veiled suicide comments are particularly serious given his history of numerous suicide attempts, including at least one within the year prior to his commitment. See Appellant's App 2 at 18. Accordingly, clear and convincing evidence exists to support that trial court's finding that C.R. is "dangerous" to himself.
3. Gravely Disabled
[¶11] "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 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." I.C. § 12-7-2-96.
A. C.R.'s Inability to Provide for his Essential Human Needs
[¶12] A trial court's finding of grave disability will be maintained if there was sufficient evidence to prove that an individual was unable to provide for his basic needs. Civil Commitment of B.J. v. Eskenazi Hospital/Midtown CMHC, 67 N.E.3d 1034, 1039 (Ind.Ct.App. 2016). In B.J., our Court found evidence was presented that B.J. was able to meet his needs. Id. at 1040. B.J. was not only able to dress himself, shower, and maintain shelter at his parents' house but also maintained employment at a job that required him to work seventy hours per week and travel often. This contrasts with C.R. who, at the time of the hearing, was homeless, not allowed to return to the Wheeler Mission, a local homeless shelter, and whose brother and son had restraining orders against him. Appellant's App. 2 at 18. Dr. Monsebias testified he did not believe that C.R. could "currently" take care of his essential needs, such as food, clothing or shelter and that he often came to the hospital dehydrated. Tr. Vol. 2 at 6. Evidence on the record demonstrated that C.R. was unable to meet his essential, basic needs.
B. C.R.'s Substantial Impairment or Obvious Deterioration of his Judgment, Reasoning, or Behavior that Results in his Inability to Function Independently.
[¶13] In a commitment proceeding, the burden on the petitioner under Indiana Code § 12-7-2-96(2) is not to simply show impaired judgment that affects the ability to function independently. A.B. v. St. Vincent Hosp. and Health Care, 240 N.E.3d 166, 172 (Ind.Ct.App. 2024). Rather, the statute mandates a showing that the individual is in danger of coming to harm as a result of the impaired judgment affecting her independent functioning. Id. In A.B., although A.B. had recently been arrested, she held unusual beliefs such as believing she had a parasite, and she exhibited bizarre behavior in the hospital, there was no evidence in the record that her unusual behavior prevented her from functioning independently or caused her to come to harm. Here, C.R. came to the hospital injured and did come to harm. He had extensive sunburns on his hands and face from laying outside and his feet were injured.
[¶14] Our Supreme Court explicitly stated in Civil Commitment of T.K. that "denial of illness and refusal to medicate, standing alone, are insufficient to establish grave disability because they do not establish, by clear and convincing evidence, that such behavior 'results in the individual's inability to function independently.'" 27 N.E.3d at 276 (quoting Ind. Code 12-7-2-96(2)).
[¶15] C.R. argues he is not gravely disabled because, as Dr. Monsebias testified, C.R. had begun to voluntarily take his medication as ordered, thereby calming him down. Furthermore, C.R. assured the trial court he would continue to comply with his doctors' orders and take his medications as prescribed. In T.D., this Court declined to find T.D. gravely disabled when there was no evidence T.D. had ever harmed (or threatened to harm) herself or others and was able to maintain food, clothing, and shelter. 40 N.E.3d at 511-12. IU Health distinguishes C.R.'s condition by highlighting Dr. Monsebias's testimony that C.R. often comes to the hospital with mental impairments and physical injuries and stops taking his medication shortly after leaving the hospital, a strong indication that C.R. is unable to function independently. IU Health argues C.R.'s "diagnosis and the lack of insight into his condition compromised his ability to function independently outside the hospital setting." Appellee's Br. at 13.
[¶16] C.R. was hospitalized several times for mental illness between August 2023 and May 2024, and visited the emergency room at least ten times "this year." Tr. at 6. A history of mental illness "requiring hospitalization[]" 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. Dr. Monsebias testified that C.R. has an inability to function independently and was concerned that C.R. "has fairly poor insight into his illness." Tr. at 6. Dr. Monsebias's testimony demonstrates that C.R.'s condition has recurringly rendered him unable to function independently, and that C.R.'s behavior and inability to properly manage his condition means he will continue to face these issues. There was sufficient evidence for the trial court to conclude that C.R. is gravely disabled as defined by Indiana Code § 12-7-2-96.
Conclusion
[¶17] IU Health clearly and convincingly established C.R. is mentally ill and a danger to himself given his behavior and inability to consistently take his medication as well and that he has an inability to provide for his essential needs and function independently, which renders him gravely disabled. Therefore, we affirm the trial court's Order for involuntary regular commitment.
[¶18] Affirmed.
May, J., and Tavitas, J., concur.