In the Matter of the Civil Commitment of M.T. v. Options Behavioral Health Systems (mem. dec.) ( 2020 )

MEMORANDUM DECISION
Pursuant to Ind. Appellate Rule 65(D), FILED
this Memorandum Decision shall not be Apr 29 2020, 10:52 am
regarded as precedent or cited before any CLERK
court except for the purpose of establishing Indiana Supreme Court
Court of Appeals
the defense of res judicata, collateral and Tax Court
estoppel, or the law of the case.
ATTORNEY FOR APPELLANT ATTORNEYS FOR APPELLEE
Christopher Kunz Jenny R. Buchheit
Marion County Public Defender Stephen E. Reynolds
Indianapolis, Indiana Sean T. Dewey
Ice Miller, LLP
Indianapolis, Indiana
IN THE
COURT OF APPEALS OF INDIANA
In the Matter of the Civil April 29, 2020
Commitment of M.T. Court of Appeals Case No.
Appellant-Respondent, 19A-MH-2330
Appeal from the Marion Superior
v. Court
The Honorable Steven R.
Options Behavioral Health Eichholtz, Judge
Systems, The Honorable Melanie Kendrick,
Appellee-Petitioner. Magistrate
Trial Court Cause No.
49D08-1908-MH-34159
Pyle, Judge.
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Statement of the Case
[1] M.T. (“M.T.”) appeals the trial court’s order for his involuntary regular civil
commitment.1 M.T. argues that there was insufficient evidence to support his
regular commitment because Options Behavioral Health Systems (“Options”)
did not prove by clear and convincing evidence that he was “gravely disabled,”
as defined by INDIANA CODE § 12-7-2-96. Concluding that there was sufficient
evidence, we affirm
[2] We affirm.
Issue
Whether there was sufficient evidence to support the trial court’s order
for M.T.’s involuntary regular civil commitment.
Facts
[3] In early August 2019, thirty-nine-year-old M.T. traveled from Indianapolis to
Chicago. While in Chicago, M.T. spent his days at the library and his nights
sleeping on the streets. Eventually, M.T. called his brother, V.L., and mother
1
In Civil Commitment of T.K. v. Dep’t of Veterans Affairs, 27 N.E.3d 271, 273 n.1 (Ind. 2015), the Indiana
Supreme Court explained:
In Indiana, an adult person may be civilly committed either voluntarily or involuntarily.
Involuntary civil commitment may occur under for circumstances if certain statutorily
regulated conditions are satisfied: (1) “Immediate Detention” by law enforcement for up to
24 hours; “Emergency Detention” for up to 72 hours; (3) “Temporary Commitment” for
up to 90 days; and (4) “Regular Commitment” for an indefinite period of time that may
exceed 90 days.
(internal citations omitted).
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and informed them where he was. V.L. and M.T.’s mother drove to Chicago to
pick up M.T. As they drove back to Indianapolis, M.T. explained that “the
voices” had told him to go to Chicago and to not take his medication. (Tr. 20).
V.L. and M.T.’s mother encouraged M.T. to go to the hospital after his
Chicago trip, but he refused.
[4] On August 15, 2019, M.T. was found walking in the middle of a busy street
with his eyes closed, saying that he was a rapist and a murderer. The police
took him to Community Hospital, and a Community Hospital physician filed
an application for emergency detention. The next day, M.T. was transferred to
Options. Options then filed a Report Following Emergency Detention. This
report included a Physician’s statement signed by Dr. Richard Payne (“Dr.
Payne”), who stated that M.T. was suffering from Schizophrenia and Bipolar
Disorder and was gravely disabled. The trial court ordered M.T. to be detained
for an evidentiary hearing to be held on August 22.
[5] At the evidentiary hearing, Dr. Payne and V.L. testified. Dr. Payne testified
that he was a psychiatrist with Options, and that M.T. had a diagnosis of
Paranoid Schizophrenia. Dr. Payne testified that M.T. “presents [as] very
paranoid. He talks to himself when others, you know, when there is no one
there[,]” and that M.T. was “very guarded.” (Tr. 7). Dr. Payne explained that
upon his admission to Options, M.T. was expressing suicidal ideations.
According to Dr. Payne, M.T. had refused to eat or drink water for several
days, and his refusal was “severe” and stemmed from his mental illness. (Tr.
9). Dr. Payne testified that he was concerned about M.T. because of his
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Paranoid Schizophrenia. Specifically, Dr. Payne explained that “[M.T.]
believes that these things are so real[,]” and that he will take action to alleviate
his paranoia. (Tr. 9). Further, that action may involve harming “the people
who he feels may be after him or to end his own life.” (Tr. 9-10).
[6] Dr. Payne further testified that M.T. had no insight into his mental illness. He
explained that this lack of insight affected M.T.’s ability to seek care or take
medication. Further, Dr. Payne stated that M.T. believed he did not need
medication, and that this belief has led to multiple hospital admissions.
According to Dr. Payne, M.T. had been hospitalized ten times since 2013. Dr.
Payne believed that M.T. had been hospitalized five times in 2019, and that,
prior to being hospitalized in August 2019, M.T.’s most recent hospitalization
was in February 2019. As a result of the February hospitalization, M.T. was
temporarily committed; it terminated in May 2019.
[7] When asked how M.T.’s Paranoid Schizophrenia impacts his judgment or
ability to function independently, Dr. Payne explained that M.T. was unable to
make simple decisions, did not currently have a job, and would not be able to
hold a job because “he could not even respond to simple tasks that we were
trying to get him to do.” (Tr. 10). Dr. Payne stated that based on his treatment
of M.T., he believed that M.T. was “[g]ravely disabled and severely disabled[]”
and that “[t]his is someone [he] worr[ies] about extremely.” (Tr. 11). When
asked if M.T. presented a substantial risk of harming himself, Dr. Payne
answered in the affirmative. Dr. Payne explained that a regular commitment
was necessary because:
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[M.T.] has all of these hospitalizations just this year and he has
had over – about ten since two thousand and thirteen. You do not
get too many chances with a schizophrenic. Usually, to get well in
that time – usually something happens. You know, a lot of them
end up dead or they get so frightened and paranoid they feel that
they have to attack you or attack random people.
(Tr. 12). Dr. Payne testified that, if the regular commitment were granted, he
planned to put M.T. on a long acting injectable medication. He further
recommended that M.T. remain inpatient “for several months at first” and then
be “transfer[red] to a state facility where he could be treated longer because he
just had not gotten well.” (Tr. 13-14). Dr. Payne indicated that with treatment,
M.T.’s prognosis would be “[s]ubstantially better than it [was] now[,]” and
without treatment, “his prognosis [was] very poor[.]” (Tr. 14).
[8] M.T.’s older brother, V.L., testified about M.T.’s trip to Chicago when he spent
his days at the library and nights sleeping on the street. V.L. expressed
concerns regarding whether M.T. could independently support himself. He
explained that M.T. had previously lived in an apartment but had been evicted
because he did not pay his rent. V.L. further explained that their mother had
allowed M.T. to live with her, but that M.T. did not want to do so, preferring
instead to stay at the Wheeler Mission or to sleep on the streets. When asked
whether his brother had been taking his medication or had otherwise been
compliant with his treatment, V.L. testified that M.T. had not. Later in V.L.’s
testimony, he explained that in 2005, M.T. had claimed that voices had told
M.T. to jump out of a three-story-window, which he acted on. Additionally, in
2016, M.T. claimed the voices told him to kill himself, leading M.T. to drive
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into a highway median. V.L. stated that his brother’s illness and suicidal
behavior were “a vicious cycle.” (Tr. 21).
[9] At the conclusion of the hearing, the trial court found that M.T. was “gravely
disabled,” and granted the petition for his regular commitment. As a basis for
its decision, the court explained as follows:
The court finds that the testimony and evidence today from
the doctor as well as the brother and the fact that [M.T.]
was on a previous commitment this year in February – it
expired in May. And there ha[ve] been at least two if not
three possible admissions since then. There have been five
total admissions this year alone. Shows that would be the
least restrictive alternative at this point is a regular
commitment as a temporary commitment gave [M.T.] an
opportunity to follow up with treatment on his own and he
did not do so. The multiple admissions show that – or also
show that he is – has a substantial impairment in his
judgment that is leading to an obvious deterioration in his
ability to function as well as care for himself. Testimony
that he has not been eating in addition to again, the multiple
admissions recently show that the respondent is gravely
disabled. The court will grant a regular commitment at this
point and find it is the least restrictive.
(Tr. 25). The court also ordered that M.T. take all medications as prescribed,
attend all clinic sessions as scheduled, and maintain his address and phone
number with the court. M.T. now appeals.
Opinion
[10] On appeal, M.T. contends that there was insufficient evidence to support his
involuntary regular commitment because Options did not prove by clear and
convincing evidence that he was “gravely disabled.” “‘[T]he purpose of civil
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commitment proceedings is dual: to protect the public and to ensure the rights
of the person whose liberty is at stake.’” 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.
[11] To satisfy the requirements of due process, the facts justifying an involuntary
commitment must be shown by clear and convincing evidence. In re
Commitment of G.M., 743 N.E.2d 1148, 1151 (Ind. Ct. App. 2001). Clear and
convincing evidence is defined as an intermediate standard of proof greater than
a preponderance of the evidence and less than proof beyond a reasonable doubt.
T.D. v. Eskenazi Midtown Cmty. Mental Health Ctr., 40 N.E.3d 507, 510 (Ind. Ct.
App. 2015). In order to be clear and convincing, the existence of a fact must be
highly probable. Id. When we review the sufficiency of the evidence
supporting an involuntary commitment, we 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. (quotation and citation omitted).
[12] 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
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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, Options had the burden of proving subsections (1) and (2) by clear and
convincing evidence.
[13] M.T. does not dispute that he is mentally ill. Rather, he argues that there was
insufficient evidence to support the trial court’s conclusion that, as a result of
his mental illness, he is gravely disabled. 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.
IND. CODE § 12-7-2-96. 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 is so impaired or
deteriorated that it results in his inability to function independently. Civil
Commitment of W.S. v. Eskenazi Health, Midtown Cmty. Health, 23 N.E.3d 29, 34
(Ind. Ct. App. 2014), trans. denied.
[14] M.T. asserts that the evidence does not show that he was “gravely disabled.”
Specifically, he argues that the court “stated two reasons for finding that M.T.
was gravely disabled – he has had multiple hospital admissions and has not
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been eating[]” and that neither one of these reasons supported a finding of grave
disability. (M.T.’s Br. 9). In response, Options argues that there was sufficient
evidence that M.T. was “gravely disabled.” We agree with Options.
[15] The record reveals that there was evidence that M.T.’s judgment, reasoning, or
behavior was so impaired or deteriorated that it results in his inability to
function independently. Specifically, M.T. was found walking in the middle of
a busy street with his eyes closed, saying that he was a rapist and a murderer.
Dr. Payne testified that M.T. suffers from Paranoid Schizophrenia and that he
was “very paranoid[]” and “guarded.” (Tr. 7). The doctor explained that when
M.T. arrived at Options, M.T. expressed suicidal ideations, and refused to eat
or drink water for several days. Dr. Payne explained that M.T.’s refusal was
“severe” and stemmed from his mental illness. (Tr. 9). When asked how
M.T.’s Paranoid Schizophrenia impacts his judgment or ability to function
independently, Dr. Payne explained that M.T. was unable to make simple
decisions and would not be able to hold a job because he could not respond to
simple tasks.
[16] Additionally, there was evidence that M.T. was unable to provide for his basic
needs. Dr. Payne indicated that M.T. had no insight into his mental illness,
and that this lack of insight affected M.T.’s ability to seek care or take
medication because he did not believe he needed medication. Furthermore,
V.L. explained that he did not believe that M.T. could independently support
himself because M.T. previously had lived in an apartment but had been evicted
because he did not pay his rent. V.L. further explained that their mother
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allowed M.T. to live with her, but that M.T. did not want to do so, preferring to
stay at the Wheeler Mission or to sleep on the streets.
[17] Based upon the record, we conclude that clear and convincing evidence
supports the trial court’s determination that M.T. was gravely disabled for
purposes of his involuntary regular commitment. See, e.g., Golub v. Giles, 814
N.E.2d 1034, 1039 (Ind. Ct. App. 2004) (patient’s refusal to accept his mental
illness and cooperate with his treatment, paired with his history of mental
health issues and destructive behavior, was sufficient to support a finding of
grave disability), trans. denied. Accordingly, we affirm the trial court’s
commitment order.
[18] Affirmed.
Bradford, C.J., and Baker, J., concur.
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