In the Matter of the Civil Commitment of S.T. v. Madison State Hospital (mem. dec.) ( 2017 )

MEMORANDUM DECISION
Pursuant to Ind. Appellate Rule 65(D),
this Memorandum Decision shall not be
regarded as precedent or cited before any FILED
court except for the purpose of establishing Aug 03 2017, 5:45 am
the defense of res judicata, collateral CLERK
estoppel, or the law of the case. Indiana Supreme Court
Court of Appeals
and Tax Court
ATTORNEY FOR APPELLANT ATTORNEYS FOR APPELLEE
Valerie K. Boots Curtis T. Hill, Jr.
Indianapolis, Indiana Attorney General of Indiana
Frances Barrow
Deputy Attorney General
Indianapolis, Indiana
IN THE
COURT OF APPEALS OF INDIANA
In the Matter of the Civil August 3, 2017
Commitment of S.T., Court of Appeals Case No.
49A02-1610-MH-2401
Appellant-Respondent, Appeal from the Marion Superior
Court
v. The Honorable Steven Eichholtz,
Judge
Madison State Hospital, Trial Court Cause No.
49D08-0901-MH-2739
Appellee-Petitioner.
Barnes, Judge.
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Case Summary
[1] S.T. appeals the trial court’s denial of his motion for dismissal of regular
commitment. We affirm.
Issue
[2] S.T. raises one issue, which we restate as whether the trial court properly found
Madison State Hospital proved by clear and convincing evidence that S.T. is
dangerous to others.
Facts
[3] In September 2006, thirty-eight-year-old S.T. was accused of molesting a three-
year-old boy at his church. The State charged S.T. with child molesting. S.T.’s
I.Q. is 57, and he was found incompetent to stand trial. He was committed to
the Division of Mental Health and Addiction of the Indiana Family and Social
Services Administration, and he was housed at Logansport State Hospital. In
January 2009, Logansport State Hospital filed a petition for involuntary
commitment of S.T. A physician’s statement included with the petition stated
that S.T. suffered from “Pedophilia [and] Mild Mental Retardation.”
Appellant’s App. Vol. II p. 19. The trial court granted the petition. S.T. filed a
motion for relief from judgment, arguing that service was not proper and that
he did not meet the criteria for civil commitment. After a hearing, the trial
court denied S.T.’s motion for relief from judgment. In its findings, the trial
court noted:
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Nancy Maxwell, behavioral clinician 3 and sexual responsibility
trainer at Logansport State Hospital, testified concerning her
work with [S.T.]. She testified that she has [S.T.] in group and
individual therapy once or twice a week, and in sexual
responsibility training twice a week. She testified that [S.T.] is
definitely a danger to children. [S.T.] has admitted to four other
episodes of child molestation. Access to children was gained by
[S.T.] through the church daycare center where he spent a lot of
time. [S.T.] has admitted to watching child pornography. Ms.
Maxwell testified that [S.T.] admitted to “trolling” the
Greenwood Mall in search of children. [S.T.] drives a “hot
yellow pickup truck” that works as a “kid magnet.” Ms.
Maxwell testified that the pickup truck was a “grooming tool”
and also endearing himself to the parents of young children was
another grooming tool. [S.T.’s] preference is for young children
because “they don’t tell on him.”
Id. at 97.
[4] Each year, Logansport State Hospital filed annual reports regarding S.T., and
the trial court entered orders continuing S.T.’s commitment without hearing.
In May 2011, S.T. was transferred from Logansport State Hospital to Madison
State Hospital (“Hospital”), and the Hospital began filing the annual reports.
The trial court continued extending S.T.’s commitment without hearing. In
February 2015, hospital staff determined that S.T. was competent to stand trial.
However, the State dismissed the charges against him. S.T. remained at the
Hospital under a regular commitment.
[5] In July 2016, S.T. filed a motion for a review hearing and dismissal of the
regular commitment. At the review hearing, the Hospital presented the
testimony of Dr. Ross Nunes, S.T.’s psychiatrist since 2011, and Dr. Pamela
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Gutherie, S.T.’s clinical psychologist. The trial court entered findings of fact
and conclusions thereon as follows:
[S.T.] was originally found incompetent to stand trial, and
subsequently committed under a regular commitment on
February 3, 2009. His commitment has been renewed annually
since that time. On January 14, 2016, Madison State Hospital
filed the current periodic report. On February 1, 2016, the court
issued an order continuing the regular commitment. The matter
was heard by the court on October 19, 201[6]. Dr. Nunes
respondent’s treatment psychiatrist at Madison State Hospital
testified that the respondent suffers from pedophilia, malingering,
and mild intellectual disability all of which are mental disorders.
During the course of his commitment to state hospitals
respondent admits to having reoccurring urges to have sexual
contact with minors age 13 or younger. Respondent has chosen
for most of his stay not to participate in any of the treatment
programs designed to assist him in coping with those urges. The
psychiatrist and social worker involved [in] respondent’s care
testified that they believe he is a danger to others and if released
would be highly at risk to satisfy those urges. Their opinion is
based on his behavior within the controlled setting of the state
hospital. For most of his stay in state hospitals the respondent
has been on 15 minute intervals to check his room at night to
prevent him from attempting to enter the rooms of other patients
to engage in unwanted sexual activity. He consistently acts on
urges and impulses to violate the personal space of other patients,
and violate rules of the hospital. His [sic] been giving various
evaluations which place same in an overall risk/need category of
moderate to high.
The respondent has not engaged in any sexual acts with children
under the age of 13 within the controlled hospital setting.
However, he continues to attempt to engage in unwanted sexual
behaviors with peers. He also routinely violates rules, takes
advantage of peers and violates the rights of other patients.
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These activities coupled with the risk need assessments support a
finding that if not under a commitment in the controlled
environment of the state hospital respondent is a danger to
others. The court therefore finds:
1. Respondent is suffering from pedophilia, malingering, and
mild intellectual disability which is mental illness as
defined in IC 12-7-2-130.
2. Respondent is a danger to others, as defined by IC 12-7-2-
53.
3. Respondent is in need of commitment to an appropriate
facility for [a] period expected to exceed ninety (90) days.
4. The appropriate facility where Respondent can receive
rehabilitative treatment or rehabilitation and care is
Madison State Hospital, which is the least restrictive
environment suitable for the necessary care, treatment and
protection of said person and others.
5. Each and every form of treatment, and each and every
alternative form of treatment has specifically been
evaluated by psychiatrists for Respondent.
6. There is not less restrictive alternative treatment and the
treatment selected is reasonable and restricts the
Respondent’s liberty in the least possible degree.
It is therefore ordered that [S.T.], Respondent, is accordingly
committed to the designated facility, where Petitioner is granted an
order to treat with medications unless Respondent does not
specifically benefit from the medications, until the Respondent is
discharged or until the Court terminates the commitment.
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Appellant’s App. Vol. II pp. 14-15. S.T. now appeals.
Analysis
[6] S.T. challenges the trial court’s continuation of his commitment. “‘[T]he
purpose of civil commitment proceedings is dual: 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) (quoting In re
Commitment of Roberts, 723 N.E.2d 474, 476 (Ind. Ct. App. 2000)). “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. (citing Addington
v. Texas, 441 U.S. 418, 425-26, 99 S. Ct. 1804 (1979)). “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.’” Id. (quoting Commitment of J.B. v.
Midtown Mental Health Ctr., 581 N.E.2d 448, 450 (Ind. Ct. App. 1991), trans.
denied).
[7] In reviewing the sufficiency of the evidence supporting a determination made
under the statutory requirement of clear and convincing evidence, we will
affirm if, “‘considering only the probative evidence and the reasonable
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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.’” Id. (quoting Bud Wolf Chevrolet, Inc. v.
Robertson, 519 N.E.2d 135, 137 (Ind. 1988)). This appellate standard of review
applies in civil commitment decisions. Id.[8] The Hospital was required to prove by clear and convincing evidence that S.T.
“is mentally ill and either dangerous or gravely disabled” and that S.T.’s
continued commitment was appropriate. Ind. Code § 12-26-2-5. At least
annually, the Hospital is required to file with the court a review of the
individual’s care and treatment. I.C. § 12-26-15-1. The review must contain a
statement of:
(1) The mental condition of the individual.
(2) Whether the individual is dangerous or gravely disabled.
(3) Whether the individual:
(A) needs to remain in the facility; or
(B) may be cared for under a guardianship.
Id.
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[9] S.T. challenges the trial court’s finding that he is dangerous.1 Indiana Code
Section 12-7-2-53 defines “dangerous” 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.” The trial court found:
[S.T.] continues to attempt to engage in unwanted sexual
behaviors with peers. He also routinely violates rules, takes
advantage of peers and violates the rights of other patients.
These activities coupled with the risk need assessments support a
finding that if not under a commitment in the controlled
environment of the state hospital respondent is a danger to
others.
Appellant’s App. Vol. II p. 14.
[10] The Hospital presented evidence regarding S.T.’s dangerousness. Dr. Nunes
testified that S.T. has urges to have sexual contact with children, that S.T. has
admitted to contact with more than one child, and that S.T.’s daily behaviors
demonstrate “the consistent violation of others rights and boundaries.” Tr. p.
11. Dr. Nunes believed that S.T. was “dangerous to others by virtue of his
ongoing pedophilic urges.” Id. at 13. He testified:
[S.T.] has expressed to me repeatedly over time including
recently, an ongoing predilection towards having sexual fantasies
of young male children. And one of the most common things
1
S.T. does not contest the trial court’s finding that he is mentally ill; however, he does dispute the trial
court’s finding that he suffers from pedophilia. S.T. does not present “detailed argument on this point”
because the finding of pedophilia “is not necessary for a finding of mental illness . . . .” Appellant’s Br. p. 12.
Consequently, we do not address the issue.
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that I ask him about is you know, whether or not the medication
that I am prescribing him is giving him any degree of relief from
those urges, and he explains to me on the one hand yes it give
him some degree of relief. But simultaneously he explains to me
that his struggle is so significant that when I ask him as I
routinely do, what if you were to not be in the hospital at this
time what could you do – what steps could you take so that you
would not sexually molest a child. And his most consistent
answer to me is that he would have to one hundred percent avoid
children. Not physically be in their vicinity.
Id. at 13. Dr. Nunes also testified that the treatment team has been concerned
over S.T.’s treatment of others and that, because of their concerns, S.T. was
placed on fifteen-minute checks at night to prevent him from entering the room
of another patient and exploiting or harming him or her. S.T. has also
repeatedly acted out sexually with his peers at the hospital even when his peers
have refused to consent. S.T. has difficulty controlling his impulses, plots
“discord between certain peers and himself, certain peers and each other,” and
difficulty keeping himself on task while avoiding engaging in disruptive
behavior. Id. at 16. Although sex offender treatment programs are available at
the Hospital, S.T. has, until recently, refused to fully participate in the
programs. Approximately seven to ten days before the hearing, S.T. “suddenly
rearticulated a desire to participate” in the treatment. Id. at 18. Overall,
however, his participation has been “sporadic” and “minimal.” Id. Because
S.T. has not been “very engaged” in sex offender treatment, he is not able to
“articulate triggers or coping mechanisms, or coping skills,” and S.T. has
shared his concerns that he would reoffend. S.T. has been prescribed a
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medication to “diminish testosterone levels” and reduce “sexual aggression.”
Id. Despite the medication, S.T. continues to act out sexually.
[11] Dr. Gutherie testified that S.T. has admitted that “his primary sexual attraction
is to young male children.” Id. at 56. S.T. had recently told Dr. Gutherie that
“without further treatment if he were to go back into the community that he
would probably reoffend.” Id. Dr. Gutherie believed, based on some of S.T.’s
behaviors, that he also would “probably not respect the boundaries and rights of
other people who he is sexually attracted to . . . .” Id. at 57. Dr. Gutherie
prepared a psychological evaluation of S.T. She found that S.T. was at a
“relatively high risk of reoffending.” Id. at 62.
[12] S.T. argues that Dr. Nunes’ testimony, Dr. Guthrie’s testimony, and the
Hospital’s documentation do not prove by clear and convincing evidence that
S.T.’s behavior supports a finding of dangerousness. S.T. challenges the basis
for the fifteen-minute night time checks, the lack of specific examples of
dangerous conduct, and changing standards in the Hospital’s definition of
inappropriate sexual behavior. S.T. also challenges the risk assessment tools
and methodology that Dr. Guthrie used in assessing S.T.’s risk of reoffending.
S.T. argues that Dr. Guthrie’s “unreasonable opinion about S.T.’s ‘urges’
reveals a lack of understanding of mental retardation and cognitive disability.”
Appellant’s Br. p. 25. Finally, S.T. argues that his own admissions do not
constitute clear and convincing evidence of dangerousness because he is
susceptible to suggestion. According to S.T., his “own uncorroborated
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admissions to prior criminal conduct have little evidentiary value.” Appellant’s
Reply Br. p. 4.
[13] S.T.’s arguments are merely a request that we reweigh the evidence, which we
cannot do. Civil Commitment of T.K., 27 N.E.3d at 273. The Hospital presented
clear and convincing evidence that S.T. remains a danger to others. Despite
years of treatment and medication to reduce his sexual desires, S.T. continues
to act out sexually. S.T. also continues to break Hospital rules, struggles with
impulsive behavior, fails to get along with his peers, and fails to fully participate
in sex offender treatment programs. His treatment team believed that his
inability to control his behavior and lack of progress did not bode well for his
ability to control his urges outside of the Hospital setting. The trial court’s
finding that S.T. is dangerous to others is not clearly erroneous.
Conclusion
[14] The Hospital presented clear and convincing evidence that S.T is a danger to
others. Consequently, the trial court properly continued S.T.’s commitment.
We affirm.
[15] Affirmed.
Baker, J., and Crone, J., concur.
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