Commitment of K K ( 2023 )

FILED
Aug 01 2023, 8:50 am
CLERK
Indiana Supreme Court
Court of Appeals
and Tax Court
ATTORNEY FOR APPELLANT ATTORNEYS FOR APPELLEE
Valerie K. Boots Jenny B. Buchheit
Marion County Public Defender Agency Sean T. Dewey
Indianapolis, Indiana Alexandria H. Pittman
Ice Miller LLP
Indianapolis, Indiana
IN THE
COURT OF APPEALS OF INDIANA
In the matter of the Civil August 1, 2023
Commitment of: Court of Appeals Case No.
23A-MH-114
K.K.,
Appeal from the
Appellant-Respondent, Marion Superior Court
v. The Honorable
Steven Eichholtz, Judge
Community Health Network, The Honorable
Inc., Melanie Kendrick, Magistrate
Appellee-Petitioner Trial Court Cause No.
49D08-2212-MH-43185
Opinion by Judge Vaidik
Judges Mathias and Pyle concur.
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Vaidik, Judge.
Case Summary
[1] K.K. appeals the trial court’s order involuntarily committing her to Community
Health Network, Inc. (“the Hospital”). In addition to challenging the
sufficiency of the evidence, K.K. argues the court erred in allowing her doctor
to testify as an expert under Indiana Evidence Rule 702. Her doctor, although
still a resident, had graduated medical school and had been treating patients for
several months. The trial court determined this was sufficient knowledge and
experience to qualify as an expert, and we cannot say this was an error. And
because we find there is sufficient evidence to support the involuntary
commitment, we affirm.
Facts and Procedural History
[2] In the early morning hours of December 13, 2022, residents of a home in
Marion County called police and reported K.K., whom they did not know, had
been standing on their front porch for hours, clothed only in pajamas. Police
believed K.K. was displaying “erratic behavior” and took her to the Hospital,
where she was admitted. Tr. Vol. II p. 11.
[3] Over the next few days, Dr. Beatrice Thunga, a psychiatry resident at the
Hospital, examined K.K. and found her to have a “disorganized thought
process” and “disorganized behavior.” Id. at 12. Specifically, K.K. was “barely
talking” and, when she did talk, was “incoherent.” Id. at 13. When asked
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questions, she would not reply and instead produced items, such as a crayon or
a piece of paper, but could not explain their significance. Furthermore, she was
“unable to express emotions” and did not understand that she had a mental
illness or needed to take medication. Id. Based on her behavior and prior
medical history, including an involuntary commitment earlier that year, doctors
at the Hospital diagnosed K.K. with schizoaffective disorder, bipolar type. On
December 15, a report was filed with the court requesting temporary
involuntary commitment (up to ninety days).
[4] An evidentiary hearing was held on December 20. Dr. Thunga testified that she
had recently graduated medical school in May 2022, held a temporary medical
license, and was six months into her residency at the Hospital. For four of those
months, she had been working in psychiatry, which she identified as the
“particular focus of [her] training.” Id. at 7-8. She primarily worked with adult
patients “with various mental disorders of mood, substance use and psychosis.”
Id. at 8. Over K.K.’s objection, the trial court found Dr. Thunga met the
qualifications as an expert in psychiatry.
[5] Dr. Thunga testified she had examined K.K. nine times since her admission
and confirmed that K.K. had been diagnosed with schizoaffective disorder,
bipolar type. Dr. Thunga stated K.K. suffered from “poverty of speech,”
meaning that K.K. was “barely talking” and often “incoherent” when she did
speak. Id. at 13. Dr. Thunga expressed that K.K. showed “declining cognition”
and was unable to coherently answer questions about her medical care,
housing, or basic needs. Id. Dr. Thunga also noted that it appeared K.K. was
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not showering, had been wearing the same clothes for almost a week, and was
not eating. A friend of K.K.’s testified at the hearing and stated he could give
her a temporary place to stay should she be released but could not offer any
permanent housing and was unwilling to be responsible for her taking
prescribed medication or attending medical appointments.
[6] After the hearing, the trial court entered an order of temporary commitment not
to exceed ninety days.
[7] K.K. now appeals.1
Discussion and Decision
I. Expert Testimony
[8] K.K. first argues the trial court erred in allowing Dr. Thunga to testify as an
expert witness under Indiana Evidence Rule 702, which provides,
(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.
1
As K.K. acknowledges, her commitment expired on March 20, 2023. But the Hospital does not argue the
appeal should be dismissed as moot. Therefore, we will address the issues raised by K.K.
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(b) Expert scientific testimony is admissible only if the court is
satisfied that the expert testimony rests upon reliable scientific
principles.
“Two requirements must be met for a witness to qualify as an expert.” Totton v.
Bukofchan, 80 N.E.3d 891, 894 (Ind. Ct. App. 2017). “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.[9] The trial court is considered the gatekeeper for the admissibility of expert
opinion evidence under Rule 702. McDaniel v. Robertson, 83 N.E.3d 765, 773
(Ind. Ct. App. 2017). 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. Id. at 772. 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. Id. at 773.
[10] K.K. argues the Hospital did not show Dr. Thunga had sufficient experience to
qualify as an expert. Dr. Thunga completed four years of medical school and
held a temporary medical license. She had been through six months of
residency, four of which focused on psychiatry. She identified psychiatry as the
focus of her training and had experience treating adults with “various mental
disorders of mood, substance use and psychosis.” And she was K.K.’s treating
physician, examining her nine times while she was there. Given this evidence,
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and the deference given to trial courts in these circumstances, we cannot say the
court erred in determining Dr. Thunga met the qualifications for an expert
witness.
II. Sufficiency of the Evidence
[11] K.K. also argues that even with Dr. Thunga’s testimony, the evidence is
insufficient to support her involuntary commitment. Civil-commitment
proceedings have two purposes—to protect both the public and the rights of the
person for whom involuntary commitment is sought. A.S. v. Ind. Univ. Health
Bloomington Hosp., 148 N.E.3d 1135, 1138 (Ind. Ct. App. 2020). The liberty
interest at stake in a civil-commitment proceeding goes beyond a loss of one’s
physical freedom because commitment is accompanied by serious stigma and
adverse social consequences. Id. Accordingly, proceedings for civil commitment
are subject to the requirements of the Due Process Clause. Id.[12] To satisfy due process, a person may not be committed without clear and
convincing evidence in support. Id. at 1139. The clear-and-convincing-evidence
standard is “an intermediate standard of proof greater than a preponderance of
the evidence and less than proof beyond a reasonable doubt.” B.J. v. Eskenazi
Hosp./Midtown CMHC, 67 N.E.3d 1034, 1038 (Ind. Ct. App. 2016). Under this
standard, “we 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
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proven by clear and convincing evidence.” A.S., 148 N.E.3d at 1139 (quotation
omitted).
[13] To obtain an involuntary commitment, the petitioner is required to prove by
clear and convincing evidence that (1) the person is mentally ill and either
dangerous or gravely disabled and (2) detention or commitment of the person is
appropriate. Ind. Code § 12-26-2-5(e).
A. Mentally Ill
[14] First, K.K. argues the Hospital did not prove by clear and convincing evidence
that she was mentally ill. A mental illness is defined as a psychiatric disorder
that substantially disturbs an individual’s thinking, feeling, or behavior and
impairs the individual’s ability to function. I.C. § 12-7-2-130.
[15] Dr. Thunga diagnosed K.K. with schizoaffective disorder, bipolar type.
Specifically with K.K., Dr. Thunga testified that this manifests in “poverty of
speech,” noting K.K. barely talked, and when she did, she was incoherent.
Furthermore, Dr. Thunga testified that K.K. was experiencing declining
cognition and could not answer questions, express emotion, or understand her
medical needs. This is sufficient evidence from which the trial court could have
determined K.K. was mentally ill. See G.Q. v. Branam, 917 N.E.2d 703, 707
(Ind. Ct. App. 2009) (diagnosis of psychiatric disorder and reports of delusional
thoughts sufficient to show mental illness). K.K. offers alternative explanations
for this behavior, such as she was protesting her admission to the Hospital, but
this is a request to reweigh evidence, which we do not do.
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B. Gravely Disabled
[16] Finally, K.K. argues the Hospital did not prove by clear and convincing
evidence that she was gravely disabled. We first note that, while Section 12-26-
2-5(e)(1) is disjunctive (“either dangerous or gravely disabled”), the Hospital did
not argue at the hearing, nor does it now contend, that K.K. was dangerous.
Instead, it argues only that she was gravely disabled. “Gravely disabled” is
defined as a condition that causes an individual to (1) be unable to meet their
basic food, clothing, and shelter needs or (2) be so obviously impaired in
judgment, reasoning, or behavior that such individual cannot function
independently. I.C. § 12-7-2-96.
[17] Dr. Thunga’s testimony establishes that K.K. was unable to meet her needs. Dr.
Thunga testified that in the five days K.K. was hospitalized, she did not appear
to be eating, never changed clothes or showered, and would not take prescribed
medication. Furthermore, K.K. was experiencing poverty of speech and
cognitive decline. At no point in the nine examinations over five days was K.K.
able to coherently communicate with Dr. Thunga about her medical needs or
housing situation. And while K.K. had a friend who was willing to house her
temporarily, he could not commit to housing her long term and was unwilling
to take responsibility for any of her medications. Ultimately, K.K.’s inability to
communicate, combined with her hygiene, food, and housing issues, supports
the trial court’s determination that she was gravely disabled. See T.A. v. Wishard
Health Servs., Midtown Cmty. Mental Health Ctr., 950 N.E.2d 1266, 1271 (Ind. Ct.
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App. 2011) (patient’s inability to explain to doctors how to meet her basic
needs, including housing, showed she was gravely disabled).
[18] Affirmed.
Mathias, J., and Pyle, J., concur.
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