In the Matter of the Mental Health Proceedings of B.M. v. Indiana University Health Hospital

FOR PUBLICATION Jan 07 2015, 10:27 am
ATTORNEY FOR APPELLANT: ATTORNEY FOR APPELLEE:
KARA A. HANCUFF JAMES L. WHITLATCH
Monroe County Public Defender KATHRYN DeWEESE
Bloomington, Indiana Bunger & Robertson
Bloomington, Indiana
IN THE
COURT OF APPEALS OF INDIANA
IN THE MATTER OF THE MENTAL )
HEALTH PROCEEDINGS OF B.M. )
)
Appellant-Respondent, )
)
vs. ) No. 53A04-1405-MH-210
)
INDIANA UNIVERSITY HEALTH, )
HOSPITAL )
)
Appellee-Petitioner. )
APPEAL FROM THE MONROE CIRCUIT COURT
The Honorable Stephen R. Galvin, Judge
Cause No. 53C07-1403-MH-103
January 7, 2015
OPINION – FOR PUBLICATION
MATHIAS, Judge
B.M. appeals the Monroe Circuit Court’s order involuntarily committing him to a
mental health facility. Specifically, B.M. argues that Indiana University Health (‘the
Hospital”) did not present sufficient evidence to support his involuntary commitment.
We affirm.
Facts and Procedural History
On March 28, 2014, B.M. placed a 911 call from the Ellettsville Library to the
police because he was worried that people were obtaining his personal information
through a social network. The police transported B.M. to the Hospital where he was
examined by an emergency room physician and a social worker. Both the physician and
the social worker believed that B.M. was psychotic and paranoid and a potential threat to
the safety of others. Appellant’s App. pp. 3-4. Therefore, the Hospital filed an application
for emergency detention. The trial court authorized B.M.’s emergency detention and he
was admitted to the Hospital.
On April 1, 2014, the Hospital filed a “Report Following Emergency Detention.”
Dr. A.P. Griffith examined B.M. and found “probable cause to believe that [he] is
suffering from a psychiatric disorder and is dangerous . . . and requires continuing care
and treatment.” Id. at 6. Specifically, Dr. Griffith observed that B.M. is “very
threatening/psychotic. Angry[.] Upset. Refuses care.” Id. at 10. Dr. Griffith also
believed that B.M. is dangerous and as a result of his psychiatric disorder, B.M. “presents
a substantial risk that he” will harm others. Id. at 11. The doctor opined that B.M. “is in
need of custody, care, or treatment in an appropriate facility.” Id. at 11.
2
Also, on April 1, 2014, Jennifer Kaladow, Ph.D. filed a petition for involuntary
commitment. Dr. Kaladow also agreed with Dr. Griffith that B.M. was suffering from a
psychiatric disorder. Specifically, Dr. Kaladow noted that B.M. is “extremely psychotic.
He is quite angry, upset & very threatening. He has been refusing treatment.” Id. at 9.
The trial court held a hearing on the Hospital’s petition on April 8, 2014. Dr.
Griffith testified that during his emergency detention at the Hospital, B.M. “has been
quite delusional.” Tr. p. 2. B.M. believes
that he is in fact in charge of the [] Securities Exchange Commission and
that he is running websites throughout America and the world, believes that
he has powers and abilities that one would typically say are not possible or
true. [B.M.] does not believe that he has a mental illness. He believes that
he is perfectly normal. He thinks that all the healthcare practitioners who
have seen him are wrong.
Tr. pp. 2-3. Dr. Griffith stated that B.M. generally refuses to take medication and will not
take his medication on a routine basis. B.M. sleeps only one to two hours per night. The
doctor also testified that B.M. has an inflated self-esteem and “undoubtedly has bipolar
mania disease.” Tr. p. 3.
Dr. Griffith’s believes that B.M. “is a threat to others if he does not get his way.
He becomes irritable, hostile and has been in restraints and fighting staff on several
occasions.” Id. B.M. blames the Hospital staff for his hostile behavior. Dr. Griffith
recommended that B.M. be committed to the Hospital for ninety days.
The trial court issued an Order of Commitment on April 8, 2014. The court
concluded that B.M. suffers from mental illness, i.e. bipolar mania, and is dangerous to
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others. Therefore, the court ordered B.M. involuntarily committed to an appropriate
facility for a period not to exceed ninety days. B.M. now appeals.
Standard of Review
When we review whether the evidence supports an involuntary mental health
commitment, we consider only the evidence and reasonable inferences therefrom most
favorable to the trial court’s judgment. In re Involuntary Commitment of A.M., 959
N.E.2d 832, 834-35 (Ind. Ct. App. 2011). We cannot reweigh the evidence or judge the
credibility of witnesses. Id. at 835. If the trial court’s commitment reflects a conclusion
that a reasonable person could have made, we will affirm the order even if other
reasonable conclusions are possible. Id.Discussion and Decision
In Indiana, a court may order a temporary commitment of not more than ninety
days for an individual who is mentally ill and either dangerous or gravely disabled. Ind.
Code § 12-26-6-1. B.M. argues that the Hospital failed to prove, by clear and convincing
evidence, that he is a dangerous individual, and therefore, the trial court’s involuntary
commitment order is not supported by sufficient evidence.1
“Civil commitment is a significant deprivation of liberty that requires due process
protections.” C.J. v. Health & Hosp. Corp. of Marion County, 842 N.E.2d 407, 409 (Ind.
Ct. App. 2006) (citing Addington v. Texas, 441 U.S. 418, 425 (1979)). “Because
1
The issue raised in this appeal is arguably moot because ninety days have elapsed since the trial court
issued its order, and B.M. has likely been released from his involuntary commitment. However, we will
address the issue raised in this appeal on its merits because, as we stated in In re Commitment of J.B., 766
N.E.2d 795, 798 (Ind. Ct. App. 2002), “[t]he question of how persons subject to involuntary commitment
are treated by our trial courts is one of great importance to society” and is likely to recur.
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everyone exhibits some abnormal conduct at one time or another, loss of liberty calls for
a showing that the individual suffers from something more serious than is demonstrated
by idiosyncratic behavior.” Commitment of M.M. v. Clarian Health Partners, 826 N.E.2d
90, 97 (Ind. Ct. App. 2005), trans. denied.
The petitioner is required to prove by clear and convincing evidence that the
individual is (1) mentally ill and (2) either dangerous or gravely disabled and that (3)
commitment is appropriate. Ind. Code § 12-26-2-5(e). The petitioner is not required to
prove that the individual is both dangerous and gravely disabled; however, “[t]here is no
constitutional basis for confining a mentally ill person who is not dangerous and can live
safely in freedom.” Commitment of J.B. v. Midtown Mental Health Ctr., 581 N.E.2d 448,
451 (Ind. Ct. App. 1991), trans. denied; see also M.L. v. Meridian Servs., Inc., 956
N.E.2d 752, 755 (Ind. Ct. App. 2011).
The trial court found that B.M. suffers from bipolar mania,2 and B.M. does not
dispute this finding. However, B.M. does dispute the trial court’s finding that he is
dangerous to others.3 See Appellant’s App. p. 14.
Dangerous “means a condition in which an individual as a result of mental illness,
presents a substantial risk that the individual will harm . . . 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
2
“Mental illness” is defined as a “psychiatric disorder that . . . substantially disturbs and individual’s
thinking, feeling, or behavior; and [] impairs the individual’s ability to function.” Ind. Code § 12-7-2-130.
3
The trial court did not find that B.M. is gravely disabled.
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person’s mental illness.” Commitment of C.A. v. Center for Mental Health, 776 N.E.2d
1216, 1218 (Ind. Ct. App. 2002).
“The determination of dangerousness under the involuntary commitment statute
has always been a question of fact for the trial court to decide.” Commitment of S.T. v.
Cmty. Hosp. North, 930 N.E.2d 684, 689 (Ind. Ct. App. 2010).
Only the trial court sees the witnesses on the stand, their demeanor in
testifying, their candor, or lack of candor, in disclosing facts about which
they have knowledge. Juries and trial courts, quite often, properly, give
more weight to the demeanor of witnesses than to the substance of their
statements in the determination of truth. An Appellate Court, considering
only the statements, is denied the assistance of this necessary factor.
Id. (quoting Lowman v. Lowman, 109 Ind. App. 163, 164, 33 N.E.2d 780, 785 (1941)).
In support of his argument that the record lacks clear and convincing evidence that
he is dangerous to others, B.M. attempts to analogize his case to In re Commitment of
Steinberg, 821 N.E.2d 385 (Ind. Ct. App. 2004) and J.S. v. Center for Behavioral Health,
846 N.E.2d 1106 (Ind. Ct. App. 2006). In those cases, our court concluded that the
petitioner failed to present sufficient evidence that the committed individual was
dangerous.
Unlike the circumstances in this case, in Steinberg, the only evidence was that
Steinberg had trouble controlling his anger and that, on one occasion, likely while
intoxicated, he pointed a firearm at a group of individuals who threatened him and his
roommate. The doctor who performed the psychiatric evaluation did not conclude that
Steinberg was dangerous to himself or others, just that he was gravely disabled. 821
N.E.2d at 387.
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In J.S., the psychiatrist’s primary concern was that J.S. was gravely disabled. The
doctor testified that J.S. could lash out against someone if she feels assaulted or
manipulated. We concluded that the doctor’s “vague ‘lashing out’ assertion” did not
meet the threshold of dangerousness. 846 N.E.2d at 1112. In this case, Dr. Griffith was
most concerned that B.M. was dangerous to others as evidenced by his threatening and
hostile behavior toward the hospital staff.
In this case four medical professionals examined B.M. and concluded that B.M.
suffers from mental illness. B.M.’s mental illness causes him to be delusional, psychotic,
hostile, upset, angry, and threatening. During his emergency detention at the Hospital,
B.M. had to be placed in restraints and fought with Hospital staff on several occasions.
And B.M. does not believe that he is mentally ill and refuses to take his medication. Dr.
Griffith opined that B.M. is dangerous and as a result of his psychiatric disorder, B.M.
“presents a substantial risk that he” will harm others. Appellant’s App. p. 11.
No evidence in the record indicates that B.M. has actually harmed anyone, but 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. M.Z. v. Clarian
Health Partners, 829 N.E.2d 634, 638 (Ind. Ct. App. 2005), trans. denied (citation
omitted). See e.g., In re Commitment of T.K. v. Dep’t of Veterans Affairs, 993 N.E.2d
245, 250 (Ind. Ct. App. 2013) (concluding that evidence of threats and hostility towards
hospital staff and T.K.’s denial that he suffers from mental illness established that T.K.
was a danger to others). For all of these reasons, we conclude that the trial court’s
7
finding that B.M. is a danger to others is supported by sufficient evidence. We therefore
affirm the trial court’s order of commitment.
Affirmed.
CRONE, J., concurs.
RILEY, J., dissents with opinion.
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IN THE
COURT OF APPEALS OF INDIANA
IN THE MATTER OF THE MENTAL )
HEALTH PROCEEDINGS OF B.M. )
Appellant-Respondent, )
)
vs. ) No. 53A04-1405-MH-210
)
INDIANA UNIVERSITY HEALTH, )
HOSPITAL )
)
Appellee-Petitioner. )
RILEY, Judge, dissenting
I respectfully disagree with the majority’s decision to affirm the trial court’s
involuntary commitment of B.M. Focusing on the dangerousness prong of the Statute,
the majority concluded that sufficient evidence was presented establishing B.M. to be a
danger to others. I disagree.
“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.”
I.C. § 12-7-2-53. As noted by the majority, and I agree, the “trial court is not required to
9
wait until a physical act is visited upon an individual [] before determining that an
individual poses a significant risk of harm to others.” See Commitment of Gerke, 696
N.E.2d 416, 421 (Ind. Ct. App. 1998) (Gerke had threatened his mother, damaged
property, and was overall very violent). In a similar vein, we have found the requirement
of dangerousness to be supported by a patient’s unwillingness to take medication. See,
e.g., Commitment of C.A., 776 N.E.2d 1216, 1218 (Ind. Ct. App. 2002). However, this
line of case law is precedented by the distinguishing fact that the patients had already
displayed unprovoked acts of physical aggression or had the potential to perform
unprovoked acts of physical aggression based on thought processes influenced by their
mental illness. See, e.g., M.Z. v. Clarian Health Partners, 829 N.E.2d 634, 640 (Ind. Ct.
App. 2005) (M.Z. removed a gun from his gun safe daily based on his delusional belief
that he was protecting himself). In other words, abnormal risk-taking will not support a
finding a person is dangerous as defined by statute, unless that risk-taking is caused by
mental illness. Commitment of J.B. v. Midtown Mental Health Ctr., 581 N.E.2d 448, 452
(Ind. Ct. App. 1991), trans. denied. As such, the justification to order an involuntary
commitment turns on the connection between the individual’s proclivity for
dangerousness and his or her mental illness.
I find that nexus to be absent here. “[F]our medical professionals examined B.M.
and concluded that B.M. suffers from mental illness.” Slip Op. p. 7. It was noted that
B.M. was “extremely psychotic,” “angry, and “very threatening.” (Appellant’s App. p. 9).
At the hearing, Dr. Griffith testified that B.M. fought healthcare staff on several
occasions and had to be placed in restraints. However, notably lacking from the record
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and Dr. Griffith’s testimony is an explanation that the exhibited aggressive behavior was
connected with B.M.’s delusions. Rather, Dr. Griffith agreed that B.M. has not been a
threat to the general public. Because of Dr. Griffith’s deficient testimony and the
incomplete record before us, B.M.’s clarification that he became aggressive because he
refused to be forcibly medicated is not contradictory.
Even though B.M. is irritable and hostile, a commitment cannot be based solely on
his display of idiosyncratic behavior, albeit maybe unusual and even undesirable, without
any display of danger to himself or others. As no clear and convincing evidence confirms
that B.M.’s displayed aggression derived from his delusions, I cannot conclude that B.M.
is dangerous within the perimeters of the involuntary commitment statute. Because
“[t]here is no constitutional basis for confining a mentally ill person who is not
dangerous[,]” I would reverse the trial court’s order of involuntary commitment. See
Commitment of J.B., 581 N.E.2d at 451.
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