In the Matter of the Civil Commitment of: R.S. v. St. Vincent Hospital and Health Care Center, Inc., St. Vincent Stress Center (mem. dec.) ( 2017 )

MEMORANDUM DECISION
Pursuant to Ind. Appellate Rule 65(D),
this Memorandum Decision shall not be FILED
regarded as precedent or cited before any Jul 27 2017, 10:58 am
court except for the purpose of establishing
CLERK
the defense of res judicata, collateral Indiana Supreme Court
Court of Appeals
estoppel, or the law of the case. and Tax Court
ATTORNEY FOR APPELLANT ATTORNEY FOR APPELLEE
Darren Bedwell Andrew B. Howk
Marion County Public Defender Hall, Render, Killian, Heath &
Indianapolis, Indiana Lyman
Indianapolis, Indiana
IN THE
COURT OF APPEALS OF INDIANA
In the Matter of the Civil July 27, 2017
Commitment of: Court of Appeals Case No.
R.S., 49A05-1701-MH-3
Appellant-Respondent, Appeal from the Marion Superior
Court
v. The Honorable Steven R.
Eichholtz, Judge
St. Vincent Hospital and Health Trial Court Cause No.
Care Center, Inc., St. Vincent 49D08-1612-MH-42222
Stress Center,
Appellee-Petitioner.
Pyle, Judge.
Court of Appeals of Indiana | Memorandum Decision 49A05-1701-MH-3 | July 27, 2017 Page 1 of 9
Statement of the Case
[1] R.S. appeals the trial court’s order granting St. Vincent Hospital and Health
Center’s (“St. Vincent”) petition for her involuntary temporary commitment.
She argues that there was not sufficient evidence to prove that she was “gravely
disabled,” as required for an involuntary temporary commitment. Because we
conclude that there was sufficient evidence to prove that R.S. was “gravely
disabled,” we affirm the trial court’s decision.
[2] We affirm.
Issue
Whether there was sufficient evidence to support the trial court’s
involuntary temporary commitment of R.S.
Facts
[3] From approximately 2009 to 2016, R.S. lived in North Carolina and received
treatment there for an unspecified mental illness. In 2016, R.S.’s family, who
lived in Indiana, received phone calls from police departments of “several
different cities” in North Carolina within a few days. (Tr. 14). The police
officers informed the family that R.S. had been “traveling back and forth” and
“[g]oing from shelter to shelter.” (Tr. 14). They said that they had paid for
R.S. to stay in hotel rooms and had gotten her into shelters so that she would
have a safe place to stay, but she had “continue[d] to leave and just roam the
streets.” (Tr. 14). Based on these calls, R.S.’s family went to North Carolina to
retrieve R.S. and bring her to Indianapolis.
Court of Appeals of Indiana | Memorandum Decision 49A05-1701-MH-3 | July 27, 2017 Page 2 of 9
[4] When R.S. arrived at her family’s house in Indianapolis, she got out of the car
and started “going into convulsions” and “acting [as] if she was having a
seizure.” (Tr. 15-16, 17). R.S.’s sister called 911, and R.S. was admitted to St.
Vincent. During her hospital evaluation “it became eviden[t] that it wasn’t a
medical problem but . . . a psychiatric problem.” (Tr. 13). As a result, on
November 28, 2015, St. Vincent filed with the trial court an application for
R.S.’s emergency detention. In its application, St. Vincent mentioned that R.S.
had a history of strokes, had presented with stroke-like symptoms, and had been
exhibiting bizarre behaviors, including refusing to remove her shower cap from
her face. Shortly thereafter, St. Vincent filed a report petitioning the court for
an order involuntarily committing R.S. The court scheduled a hearing on the
issue for December 5, 2016.
[5] In the meantime, R.S. became paranoid that the staff in the hospital were
poisoning her, and she refused to take her psychiatric or general health
medications, including medications she needed to treat her hypertension and
vascular problems.1 She also had delusions that she was unable to speak. Dr.
Shaun Wood (“Dr. Wood”), a psychiatrist with St. Vincent, diagnosed R.S. as
having an “unspecified psychosis” that was “of a thought disorder nature like
schizophrenia.” (Tr. 7). Dr. Wood was unable to “get much of a history” of
1
At R.S.’s commitment hearing, Dr. Shaun Wood clarified that R.S. had been “intermittently taking some of
the general medical meds but refusing psychiatric medicine except for the Viibyrd[,]” which she had been
taking “to some degree.” (Tr. 8).
Court of Appeals of Indiana | Memorandum Decision 49A05-1701-MH-3 | July 27, 2017 Page 3 of 9
R.S.’s psychosis due to R.S.’s “impaired thought process” and “inability” or
“refusal” to speak. (Tr. 7).
[6] On December 5, 2016, the trial court held its scheduled hearing on St. Vincent’s
petition for an involuntary temporary commitment of R.S. At the hearing, Dr.
Wood testified that R.S.’s thought disorder had rendered her incapable of
complying with treatment. He noted that R.S. had tried to communicate with
him through writing due to her unwillingness or inability to speak, but he had
not been able to understand what she had been trying to say due to the way her
“thought process [] present[ed] itself in written form.” (Tr. 9). He opined that,
due to R.S.’s apparent inability to effectively communicate and “think logically
enough,” she did not have the ability to provide herself with food, clothing,
shelter, or other essential human needs, or to communicate her needs to others.
(Tr. 9). As a result, Dr. Wood testified that he considered R.S. gravely disabled
and that he believed she needed in-patient treatment at St. Vincent. When
asked what concerns he would have if the trial court were to deny the petition
for temporary commitment, Dr. Wood testified that he would be concerned
that R.S. would “end up coming to harm” by failing to take her “general
medical med[icines].” (Tr. 11). He also opined that R.S. did not have the
ability to exhibit the proper judgment, reasoning, or behavior necessary to
function independently.
[7] Next, R.S.’s sister, S.S., testified that she did not believe that her sister was
capable of making appropriate decisions and that she believed temporary
commitment was in R.S.’s best interests. She explained that R.S. had started
Court of Appeals of Indiana | Memorandum Decision 49A05-1701-MH-3 | July 27, 2017 Page 4 of 9
“bouncing around from facility to facility” while she was in North Carolina
because there had “always [been] an issue with the place or someone there or
someone in her past.” (Tr. 16). Specifically, S.S. testified that R.S. had
believed that people from her past were following her, and she had continued to
make statements to that effect after she was brought to Indianapolis.
[8] At the conclusion of the hearing, the trial court granted St. Vincent’s petition
for R.S.’s involuntary temporary commitment, finding that R.S. was gravely
disabled and that placement with St. Vincent was the least restrictive
environment suitable for her treatment and stabilization. The trial court
ordered the commitment to last until March 5, 2017. R.S. now appeals.
Decision
[9] On appeal, R.S. argues that there was insufficient evidence to support her
temporary commitment.2 In reviewing the sufficiency of the evidence to
support a civil commitment, which requires clear and convincing evidence, “‘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.’” Commitment of M.E. v. Dep’t of
2
Notably, R.S.’s temporary commitment has already expired, which renders her argument moot. We
generally do not discuss moot issues, but we have found that “the question of how persons subject to
involuntary commitment are [treated] by our trial courts is one of great importance to society” that we will
address on the merits even if it is moot. Commitment of M.E. v. Dep’t of Veteran’s Affairs, 64 N.E.3d 855, 859
n.3 (Ind. Ct. App. 2016) (quoting Golub v. Giles, 814 N.E.2d 1034, 1036 n.1 (Ind. Ct. App. 2004), trans.
denied).
Court of Appeals of Indiana | Memorandum Decision 49A05-1701-MH-3 | July 27, 2017 Page 5 of 9
Veteran’s Affairs, 64 N.E.3d 855, 861 (Ind. Ct. App. 2016) (quoting Civil
Commitment of T.K. v. Dep’t of Veteran’s Affairs, 27 N.E.3d 271, 273 (Ind. 2015)
(internal quotation omitted)).
[10] INDIANA CODE § 12-26-2-5(e) provides that the petitioner in a case involving
the involuntary treatment of mentally ill individuals must 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. Clear and convincing evidence requires proof that the existence of
a fact is “highly probable.” M.E., 64 N.E.3d at 861. “‘There is no
constitutional basis for confining a mentally ill person who is not dangerous
and can live safely in freedom.’” Id. (quoting Commitment of J.B. v. Midtown
Mental Health Ctr., 581 N.E.2d 448, 451 (Ind. Ct. App. 1991), trans. denied).
[11] R.S. does not dispute the trial court’s finding that she is mentally ill. However,
she argues that there was insufficient evidence to support the trial court’s
finding that she is gravely disabled. INDIANA CODE § 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.
Court of Appeals of Indiana | Memorandum Decision 49A05-1701-MH-3 | July 27, 2017 Page 6 of 9
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 was unable to provide for his basic needs or that his
judgment, reasoning, or behavior was so impaired or deteriorated that it
resulted in his inability to function independently. Commitment of B.J. v.
Eskenazi Hosp./Midtown CMHC, 67 N.E.3d 1034, 1039 (Ind. Ct. App. 2016).
Our supreme court has previously held that a denial of mental illness and
refusal to medicate, standing alone, are insufficient to establish grave disability
because they do not establish by clear and convincing evidence that the
individual is unable to function independently. See T.K., 27 N.E.3d at 276.
The United States Supreme Court has also held that, since everyone exhibits
some abnormal conduct at one time or another, “loss of liberty [through a
commitment] calls for a showing that the individual suffers from something
more serious than is demonstrated by idiosyncratic behavior.” Addington v.
Texas, 441 U.S. 418, 426-27, 99 S.Ct. 1804, 1810 (1979).
[12] R.S. argues that there was insufficient evidence that she was gravely disabled
because the only evidence supporting that finding was the evidence that she
refused to take medication, which was insufficient according to T.K. She
claims that her refusal to speak was not evidence of a grave disability because it
was merely idiosyncratic behavior. However, R.S. overlooks the other
elements of the definition of “gravely disabled.” In addition to her refusal to
take her medication or speak, R.S. demonstrated that she was unable to provide
for her essential human needs, including shelter. Her sister testified that her
Court of Appeals of Indiana | Memorandum Decision 49A05-1701-MH-3 | July 27, 2017 Page 7 of 9
family had received phone calls from police officers in North Carolina who said
that, even when they had provided shelter for R.S. in order to keep her safe, she
had left the shelter “to roam the streets.” (Tr. 14). R.S.’s sister also clarified
that R.S.’s inability to maintain shelter resulted from her delusional beliefs that
people from her past were following her, which continued after she was brought
to Indianapolis.
[13] In addition, while R.S.’s refusal to speak might be considered idiosyncratic, it
impacted her ability to meet her needs. Dr. Wood testified that he was unable
to understand R.S.’s communications, even through writing, due to the way her
“thought process [] present[ed] itself in written form.” (Tr. 9). He opined that,
as a result of her ineffective communication, she would not be able to
communicate her needs to others sufficiently to meet her needs if she were not
committed.
[14] In light of this evidence, we conclude that there was sufficient evidence that
R.S. was unable to maintain shelter or provide for her other essential human
needs and was, thus, gravely disabled. See A.L. v. Wishard Health Servs., Midtown
Cmty. Mental Health Ctr., 934 N.E.2d 755 (Ind. Ct. App. 2010) (finding that
A.L.’s inability to maintain stable housing, inability to maintain employment,
and delusions causing a substantial impairment in judgment were sufficient
evidence to establish her grave disability). Accordingly, there was sufficient
evidence to support R.S.’s temporary commitment.
Court of Appeals of Indiana | Memorandum Decision 49A05-1701-MH-3 | July 27, 2017 Page 8 of 9
[15] Affirmed.
May, J., and Brown, J., concur.
Court of Appeals of Indiana | Memorandum Decision 49A05-1701-MH-3 | July 27, 2017 Page 9 of 9