Opinion
23A-MH-2828
05-16-2024
In the Matter of the Civil Commitment of: N.H., Appellant-Respondent v. Indiana University Health Methodist Hospital, Appellee-Petitioner
ATTORNEY FOR APPELLANT Sarah Medlin Marion County Public Defender Agency Indianapolis, Indiana. ATTORNEYS FOR APPELLEE Jenny R. Buchheit Sean T. Dewey Ice Miller LLP 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 Appellate Rule 65(D), this Memorandum Decision is not binding precedent for any court and may be cited only for persuasive value or to establish res judicata, collateral estoppel, or law of the case.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 The Honorable David J. Certo, Judge Trial Court Cause No. 49D08-2310-MH-41441
ATTORNEY FOR APPELLANT Sarah Medlin Marion County Public Defender Agency Indianapolis, Indiana.
ATTORNEYS FOR APPELLEE Jenny R. Buchheit Sean T. Dewey Ice Miller LLP Indianapolis, Indiana.
Chief Judge Altice and Judge Felix concur.
MEMORANDUM DECISION
Bradford, Judge
Case Summary
[¶1] In October of 2023, N.H. was admitted to Indiana University Health Methodist Hospital ("the Hospital"). N.H. suffers from schizoaffective disorder and experiences delusion and paranoia. Although medications have been shown to be effective at alleviating N.H.'s symptoms, he has refused to take them. The Hospital petitioned the trial court for an involuntary commitment of N.H. on the bases that he was dangerous and gravely disabled. Following a commitment hearing, the trial court granted the Hospital's petition. N.H. contends that the trial court abused its discretion in finding that Dr. Caleb Nissen qualified as an expert under Indiana Evidence Rule 702 and that the Hospital produced insufficient evidence to support his commitment. We affirm.
Facts and Procedural History
[¶2] On October 23, 2023, the Hospital filed an Application for Emergency Detention requesting continued emergency detention of then-twenty-sevenyear-old N.H. The attesting physician represented that there was probable cause to believe N.H. was mentally ill, dangerous to himself and others, and gravely disabled as he was actively psychotic, paranoid, and had threatened to kill his parents. The trial court granted the request for emergency detention. On October 26, 2023, the Hospital filed a Petition for Involuntary Commitment, alleging that N.H. was mentally ill, was dangerous to others and gravely disabled, and was in need of a regular commitment.
[¶3] On November 1, 2023, the trial court held a hearing on the Hospital's petition. N.H.'s father, D.H. ("Father"), testified that N.H. had been living with him and his wife, J.H. ("Mother"), and, for a period of approximately six months, had refused medication and had stopped attending his counseling sessions. Father further testified that N.H. had displayed aggressive, threatening, and intimidating behaviors towards him and Mother. He opined that N.H. would not "be able to live on his own, maintain a job, maintain a home, unless he's consistently on medication and provided some counseling." Tr. Vol. II p. 11. Mother also testified, outlining acts of aggression and intimidation committed against her and Father, including a threat from N.H. that there would be "consequences" if she did not comply with his demands. Tr. Vol. II p. 26. Mother and Father (collectively, "Parents") were supportive of the commitment, stating that N.H. exhibited fewer symptoms of paranoia when medicated. N.H. also testified, indicating that he would not take medication as prescribed.
[¶4] Dr. Nissen testified over N.H.'s objection that he was unqualified to testify as an expert that N.H. had been diagnosed with schizoaffective disorder and had been the subject of numerous hospitalizations. Dr. Nissen testified that he had examined N.H. four times, with the most recent examination occurring the morning of the commitment hearing. Dr. Nissen indicated that N.H. had exhibited delusional thoughts, auditory hallucinations, and disorganized thought processes, all of which "are symptoms of psychosis." Tr. Vol. II p. 32.
[¶5] In his interactions with Dr. Nissen, N.H. had expressed a belief that "someone ha[d] been messing with the things in his house, breaking into his house," indicating a neighbor might have been responsible and claiming that "a helicopter ha[d] been ... following his neighbor." Tr. Vol. II p. 33. N.H. had indicated that at one of his prior jobs, his co-workers had poisoned the drink machine. He had claimed to have reported these alleged actions to both the FDA and the FBI and, upon determining that the FDA had been unhelpful, had "put a bag of poo on the phone." Tr. Vol. II p. 34. Dr. Nissen stated that "whether or not he [had] actually put any feces on the phone[,]" N.H.'s statement reflected "what he deemed [to be] an adequate response to the situation." Tr. Vol. II p. 34. N.H. had further indicated that at another of his prior jobs, his co-workers had drowned people who had visited the water park. N.H. had stated the belief that his medications had been contaminated or changed without his consent.
[¶6] Dr. Nissen opined that there was a substantial risk that N.H. would harm others, specifically Parents and his neighbor. Dr. Nissen indicated that N.H. had shared his plan to "acquire a license to kill, as well as then purchase a gun after that." Tr. Vol. II p. 36. He opined that N.H. did not have insight into his mental illness and that his lack of insight affected his ability to seek care or take medication. While N.H. had been administered some medication since being admitted to the Hospital, he had refused his anti-psychotic medication for two reasons: first, because he had concerns it was contaminated, and second, because he did not agree with his schizoaffective-disorder diagnosis.
[¶7] Dr. Nissen indicated that it was unlikely that N.H. would voluntarily take his medication without intervention, noting that N.H. did not believe that he needed medication. In requesting a regular commitment for N.H., Dr. Nissen stated that N.H.
has had uhm multiple psychiatric hospitalizations, as well as a previous commitment which he has initially done well with, but then, uhm, subsequently has fallen out of the habit of taking his medication, uhm, and then subsequently, uhm, had, you know, sort of some decompensation in his symptoms and worsening of his symptoms, uhm, that it would be beneficial for [N.H.] to uhm to have a commitment for longer than that period of time so that we can continue to ensure that he is taking his medication and having more reality-based thinking and the ability to uhm control his emotions, demonstrate safe behavior and function independently.Tr. Vol. II p. 38. Dr. Nissen's anticipated treatment plan included a long-acting, injectable antipsychotic, which N.H. had "reportedly done well with" in the past. Tr. Vol. II p. 37. Dr. Nissen opined that the medication would be of a substantial benefit to N.H. and that the probable benefits from the anticipated treatment would outweigh the risk of harm to N.H.
[¶8] Dr. Nissen opined that, with treatment, N.H.'s prognosis was good, stating that, with treatment, N.H. would
start having .... less frequent delusion thoughts, he may still have these delusion beliefs, which his parents described, but they will be significantly less distressing to the point where he does not bring them up, you know, of his own accord and that he's able to exhibit self-control and not demonstrate aggressive language or behavior in response to those distressing beliefs. I'm also hopeful that he would be able to, you know, hold a job as he has done in the past without his paranoid delusions uhm causing such distress that he's unable to continue working.Tr. Vol. II p. 39.
[¶9] At the conclusion of that hearing, the trial court ordered a regular commitment and found that N.H. was suffering from schizoaffective disorder, was dangerous to others, and "is gravely disabled in his judgment and reasoning by his paranoia. He has a plan to acquire firearms and to use force to stop whomever he believes is persecuting him and has physically confronted his mother and father." Appellant's App. Vol. II p. 12. The trial court further found that the commitment was expected to exceed ninety days and was the least-restrictive environment suitable for N.H.'s "treatment and stabilization." Appellant's App. Vol. II p. 11.
Discussion and Decision
[¶10] 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. 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. To satisfy the requirements of due process, the facts justifying an involuntary commitment must be shown by clear and convincing evidence which not only communicates the relative importance our legal system attaches to a decision ordering an involuntary commitment, but also has the function of reducing the chance of inappropriate commitments.T.K. v. Dep't of Veterans Affs., 27 N.E.3d 271, 273 (Ind. 2015) (cleaned up). In challenging his involuntary commitment, N.H. contends that the trial court erred in certifying Dr. Nissen as an expert and that the evidence is insufficient to sustain his involuntary commitment.
I. The Trial Court Did Not Abuse its Discretion in Determining that Dr. Nissen Qualified as an Expert
[¶11] With respect to expert witnesses, Indiana Evidence Rule 702 provides as follows:
(a) A witness who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise if the expert's scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue.
(b) Expert scientific testimony is admissible only if the court is satisfied that the expert testimony rests upon reliable scientific principles.
"In adopting Evidence Rule 702, [the Indiana Supreme] Court did not intend to interpose an unnecessarily burdensome procedure or methodology for trial courts." Sears Roebuck &Co. v. Manuilov, 742 N.E.2d 453, 460 (Ind. 2001).
By requiring trial courts to be satisfied that expert opinions will assist the fact-finder and that the underlying scientific principles are reliable, Rule 702 guides the admission of expert scientific testimony. Although it authorizes the exclusion of purported scientific evidence when the trial court finds that it is based on unreliable principles, the adoption of Rule 702 reflected an intent to liberalize, rather than to constrict, the admission of reliable scientific evidence.Id.
[¶12] "Two requirements must be met for a witness to qualify as an expert." K.K. v. Cmty. Health Network, Inc., 215 N.E.3d 382, 385 (Ind.Ct.App. 2023) (internal quotation omitted), trans. denied. "First, the subject matter must be distinctly related to some scientific field, business, or profession beyond the knowledge of the average layperson; and second, the witness must be shown to have sufficient skill, knowledge, or experience in that area so that the opinion will aid the trier of fact." Id. (internal quotation omitted). "Once the trial court is satisfied that the expert's testimony will assist the trier of fact and that the expert's general methodology is based on reliable scientific principles, then the accuracy, consistency, and credibility of the expert's opinions may properly be left to vigorous cross-examination, presentation of contrary evidence, argument of counsel, and resolution by the trier of fact." Manuilov, 742 N.E.2d at 461.
[¶13] The trial court is considered the gatekeeper for the admissibility of expert opinion evidence under Rule 702. A trial court's determination regarding the admissibility of expert testimony under Rule 702 is a matter within its broad discretion and will be reversed only for abuse of that discretion. We presume that the trial court's decision is correct, and the burden is on the party challenging the decision to persuade us that the trial court has abused its discretion. K.K., 215 N.E.3d at 385. (internal citations omitted).
[¶14] N.H. argues that the Hospital did not show that Dr. Nissen had sufficient experience to qualify as an expert. We disagree. The record establishes that Dr. Nissen graduated from the University of Arkansas medical school in 2023 and began his residency at the Hospital in August of that year. Dr. Nissen specializes in general psychiatry and had both taken classes focusing on psychiatry and "worked with psychiatric patients during" medical school. Tr. Vol. II p. 30. In treating N.H., Dr. Nissen worked with Dr. Jonathan Withers, an attending physician, who had agreed with Dr. Nissen's diagnosis and treatment of N.H. Given this evidence, and the deference given to trial courts in these circumstances, we cannot say the trial court abused its discretion in determining Dr. Nissen met the qualifications for an expert witness. See K.K., 215 N.E.3d at 385 (providing that the trial court had not abused its discretion in determining that a similarly young doctor had sufficient experience to qualify as an expert under Evidence Rule 702).
II. The Evidence is Sufficient to Sustain the Trial Court's Commitment Order
[¶15] Indiana law allows for a person to be involuntarily committed if the petitioner proves 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). In order to carry its burden of proof, a petitioner need only prove that the individual "was either gravely disabled or dangerous. It [does] not have to prove both of these elements." M.Z. v. Clarian Health Partners, 829 N.E.2d 634, 637 (Ind.Ct.App. 2005), trans. denied.
[¶16] "When reviewing a challenge to the sufficiency of the evidence with respect to commitment proceedings, we will only look to the evidence most favorable to the trial court's decision and all reasonable inferences drawn therefrom." Id.
In reviewing the evidence supporting the judgment, we may neither reweigh the evidence nor judge the credibility of the witnesses. Where the evidence is in conflict, we are bound to view only that evidence that is most favorable to the trial court's judgment. If the trial court's commitment order represents a conclusion that a reasonable person could have drawn, we will affirm the order even if other reasonable conclusions are possible.Id. (internal citations and quotations omitted). N.H. argues that the Hospital produced insufficient evidence to prove that he was dangerous and gravely disabled. He also argues that the evidence is insufficient to prove that commitment was appropriate.
A. The Evidence is Sufficient to Prove that N.H. was Dangerous
[¶17] As it relates to an involuntary commitment, the term "dangerous" means "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." Ind. Code § 12-7-2-53. "Dangerousness 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) (internal quotation omitted), trans. denied.
[¶18] In its application for the emergency detention of N.H. filed on October 24, 2023, the Hospital claimed that N.H. was dangerous because he had threatened to kill his parents and was actively psychotic. A physician's statement filed by Dr. David Roznovjak further revealed that N.H. had engaged in verbal and physical aggression towards his parents and hospital staff and, because he believed that his parents and hospital staff were poisoning his food and changing his medication, N.H. had refused to eat or take his medication. Following N.H.'s emergency detention, Dr. Withers diagnosed him as suffering from schizoaffective disorder, a diagnosis that was reaffirmed by Dr. Nissen at the November 1, 2023 commitment hearing.
[¶19] Dr. Nissen testified that he had evaluated N.H. on four occasions, including the morning of the commitment hearing. During these evaluations, N.H. exhibited delusional and disorganized thoughts. He had also expressed a desire and plan to harm others, stating that he intended to acquire both "a license to kill" and a gun. Tr. Vol. II p. 36. Dr. Nissen opined that N.H. presented "a substantial risk" of harm to others, noting that N.H. had expressed a desire to harm his parents and a neighbor. Tr. Vol. II p. 36. N.H. had reiterated his desire to "acquire a license to kill" the morning of the commitment hearing. Tr. Vol. II p. 42.
[¶20] N.H.'s parents also testified that they believed that N.H. was dangerous. Father testified that N.H. had displayed aggressive and intimidating behavior towards him and Mother. On the occasion that had "led to [N.H.'s current] hospitalization[,]" N.H. had thrown a steak, which had been intended to be part of the family's dinner, at Father and, in an apparent attempt to intimidate Father, had acted as if he were going to throw a chair at Father before hitting a television stand with the chair, breaking the door to the television stand and knocking the television over. Tr. Vol. II p. 8. Father had also observed N.H. "standing in an intimidating position towards" Mother, restricting her movement. Tr. Vol. II p. 9. For her part, Mother testified that N.H. had confined her to a room and had refused to let her leave. Mother further testified that N.H. had threatened "consequences" if she did not comply with his wishes. Tr. Vol. II p. 26. When angry, N.H. had also kicked and hit walls and doors in the family's home, leaving holes, and Parents had taken to locking their bedroom door while sleeping to keep N.H. from "barg[ing] in." Tr. Vol. II p. 10.
[¶21] With regard to Parents, N.H. seems to argue that their testimony does not establish that he is dangerous because they did not testify that he had actually harmed them. The question, however, is not whether N.H. had, to-date, actually physically harmed Parents, but rather whether he was dangerous, i.e., whether he presented a substantial risk of harm to himself or others. See Ind. Code § 12-7-2-53; see also B.M. v. Ind. Univ. Health, 24 N.E.3d 969, 972 (Ind.Ct.App. 2015) (providing that a trial court is not required to wait until an individual commits a physical act before determining that the individual poses a substantial risk of harm to others), trans. denied. The evidence establishes that N.H. had thrown an object at Father, acted as if he was going to throw a different object at Father, confined Mother and had limited her movements, and threatened "consequences" if she did not comply with his wishes. Tr. Vol. II p. 26. Like the trial court, we conclude that this evidence is sufficient to prove that N.H. presented a substantial risk of harm to Parents.
[¶22] As for his desire to obtain a so-called "license to kill," N.H. points to his testimony at the commitment hearing, indicating that he no longer believed that he would be able to obtain such a license. This evidence directly contradicts Dr. Nissen's testimony that N.H. had expressed a desire to obtain such a license on the morning of the commitment hearing. The trial court was under no obligation to credit N.H.'s testimony and apparently did not. See Thompson v. State, 804 N.E.2d 1146, 1149 (Ind. 2004) (providing that a factfinder is not required to believe a witness's testimony). N.H.'s sufficiency challenge effectively amounts to a request for this court to reweigh the evidence, which we will not do. See M.Z., 829 N.E.2d at 637.
Because we conclude that the evidence is sufficient to support the trial court's determination that N.H. was dangerous to himself or others, we need not address the question of whether he is gravely disabled. See M.Z., 829 N.E.2d at 637 (providing that because the statute is written in the disjunctive, a petitioner need only prove that the individual was either gravely disabled or dangerous).
B. The Evidence is Sufficient to Prove that Detention or Commitment of N.H. is Appropriate
"The determination of whether an involuntary commitment is appropriate is fact-sensitive." R.P. v. Optional Behav. MHS, 26 N.E.3d 1032, 1037 (Ind.Ct.App. 2015). Dr. Nissen opined that N.H. lacked insight into his mental illness, which affected his ability to seek care or take medication. N.H. indicated to Dr. Nissen that he believed that his medication had been contaminated and that he had been misdiagnosed with schizoaffective disorder. Again, in requesting a regular commitment for N.H., Dr. Nissen stated that N.H. had had numerous psychiatric hospitalizations and, when compliant with his medications, had done well. However, he has demonstrated a pattern of only short-term medication compliance, with his symptoms worsening when he is not taking his medication. Dr. Nissen opined that a commitment for longer than ninety-days would be beneficial to N.H., so to allow doctors the ability to "ensure that he is taking his medication and having more reality-based thinking and the ability to uhm control his emotions, demonstrate safe behavior and function independently." Tr. Vol. II p. 38. Dr. Nissen indicated that it was unlikely that N.H. would voluntarily take his medication without intervention, noting that N.H. did not believe that he needed medication. Dr. Nissen's anticipated treatment plan included a long-acting, injectable antipsychotic, which N.H. had "reportedly done well with" in the past. Tr. Vol. II p. 37. Dr. Nissen opined that the medication would be a substantial benefit to N.H. and that the probable benefits from the anticipated treatment would outweigh the risk of harm.
[¶23] Dr. Nissen testified that the above-described treatment plan was the least-restrictive treatment available to bring about an improvement in N.H.'s condition. The evidence supports the determination that without commitment, N.H. would be unlikely to submit to the necessary treatment. The evidence is therefore sufficient to sustain the trial court determination that commitment was appropriate. Again, N.H.'s challenge to the sufficiency of the evidence effectively amounts to an invitation to reweigh the evidence, which we will not do. See M.Z., 829 N.E.2d at 637.
[¶24] The judgment of the trial court is affirmed.
Altice, C.J., and Felix, J., concur.