In re the Civil Commitment of C.B. v. Eskenazi Health Midtown Community Mental Health (mem. dec.)

MEMORANDUM DECISION
Pursuant to Ind. Appellate Rule 65(D), FILED
this Memorandum Decision shall not be
regarded as precedent or cited before any May 04 2017, 8:20 am
court except for the purpose of establishing CLERK
Indiana Supreme Court
the defense of res judicata, collateral Court of Appeals
and Tax Court
estoppel, or the law of the case.
ATTORNEY FOR APPELLANT ATTORNEYS FOR APPELLEE
Darren Bedwell Phyllis J. Garrison
Marion County Public Defender Eskenazi Health
Indianapolis, Indiana Indianapolis, Indiana
IN THE
COURT OF APPEALS OF INDIANA
In re the Civil Commitment of May 4, 2017
C.B., Court of Appeals Case No.
Appellant-Respondent, 49A04-1606-MH-1256
Appeal from the Marion Superior
v. Court, Probate Division
The Honorable Steven R.
Eskenazi Health Midtown Eichholtz, Judge
Community Mental Health, Trial Court Cause No.
Appellee-Petitioner 49D08-1605-MH-17646
Mathias, Judge.
[1] C.B. appeals the Marion Superior Court’s order involuntarily committing him
to the Health & Hospital Corporation of Marion County d/b/a Eskenazi
Health Midtown Community Mental Health (“Eskenazi Health”) for a period
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not expected to exceed ninety days. Concluding that the temporary
commitment order is supported by clear and convincing evidence, we affirm.
Facts and Procedural History
[2] C.B. is a 72-year-old retired science teacher. On an unknown date in mid-May
2016, C.B. was found in an alleyway and told a police officer that he was
“working on a government program to import Russian women.” Tr. p. 9. He
was taken to Methodist Hospital in Indianapolis but was not detained.
[3] On May 16, 2016, C.B. called 911 to report that an FBI agent had been killed.
Police officers found no evidence that C.B.’s report was accurate. C.B. was
admitted to Eskenazi Health’s Crisis Intervention Unit that night but was
released. The next day, May 17, 2016, a police officer took C.B. to Eskenazi
Health, and he was admitted because he was “very delusional.” Tr. p. 8.
[4] On May 18, 2016, Eskenazi Health filed an application for emergency
detention. Shortly thereafter, it filed a report and physician’s statement alleging
that C.B. suffered from an “unspecified psychotic disorder” and that he was
gravely disabled. Appellant’s App. pp. 12-16. The trial court held a hearing on
Eskenazi’s application on May 26, 2016.
[5] Dr. Thomas Beesley, a psychiatry resident, testified that C.B. reported that he
was a member of the FBI and he needed to be released from the hospital to go
to orientation. C.B. also told the doctor that he was “an elite member of the
Republican Party” and the party was working “diligently” to get C.B. out of the
hospital. Tr. p. 9. C.B. told numerous individuals that he was the President-
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elect of the United States. C.B. also stated to numerous Eskenazi Health
employees that he was recommending them for cabinet positions. Tr. p. 10.
[6] After reviewing C.B.’s medical records and examining him, Dr. Beesley
concluded that C.B. suffers from a psychotic disorder. Dr. Beesley also believed
that C.B. was homeless because C.B. gave the doctor several different
explanations for his lack of housing and his living situation if he were
discharged from the hospital. Id. Dr. Beesley opined that C.B. is gravely
disabled because he does not understand his mental illness, cannot function
independently, and will not follow up on his treatment plan.
[7] Dr. Beesley prescribed Risperdal, but also discovered that C.B. has a vitamin
B12 deficiency that is likely triggering his psychosis. Tr. p. 12. In addition, “B12
deficiency can cause more severe symptoms. Mainly neurologic symptoms
which can progress theoretically to the point of death.” Tr. p. 14. Dr. Beesley
started C.B. on “IM B12 replacement” injections, and C.B. was willing to take
those. Tr. p. 15. Dr. Beesley stated that C.B. would need the injections for up to
fourteen days. Treatment on an out-patient basis was possible but “the
discharge plans that C.B. [] proposed ha[d] all been delusional based.” Tr. p.
16.
[8] Dr. Beesley did not believe that C.B. would voluntarily continue his treatment
plan.
I believe his inability to cooperate and to have medical decision
making capacity is all directly related to his psychosis and his
delusional beliefs. And with that being said, even with the B12
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replacement, it’s clear there are other medical conditions going
on and he’s not allowing us to work those medical conditions up.
And it is possible that the psychosis won’t improve with the B12
injections because it’s being caused by another medical
condition.
Tr. pp. 16-17. The doctor also expressed the need for C.B. “to have housing and
[a] stable environment where we could . . . have him actually come back for
clinic appointments. And get subsequent B12 injections.” Tr. p. 18.
[9] C.B. did not agree with Dr. Beesley’s diagnosis and wanted a second opinion
from a doctor at St. Vincent’s Hospital. C.B. believed that Dr. Beesley was a
poor doctor who needed money, who “is trying to achieve more status so he
can do . . . more intrusions into my body that are not necessary.” Tr. p. 38.
[10] C.B.’s testimony at the commitment hearing also established that on May 17,
2016, the date he was admitted to Eskenazi, he did not have stable housing. Tr.
pp. 34-35 (explaining that the day he was detained he was trying to find a safe
place to stay for the night). C.B. still suffered from delusions at the hearing and
continued to believe that the FBI had a certificate, badge, gun, and holster
waiting for him but he had not had training yet. Tr. pp. 36-37. C.B. could not
recall placing a 911 call claiming that an FBI agent had been shot. C.B. also
testified that the Republican Party was going to employ him and give him a
gun, badge, and holster. Tr. p. 53. He testified that the Republican Party was
preparing him to run for president in four years. Tr. p. 56. Finally, C.B. said he
receives a social security check each month and stated that if he was released
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from the hospital he could stay with a friend who lives in Kokomo or possibly
near his brother in Crown Point.
[11] After the hearing and argument by the parties, the trial court issued an order of
temporary commitment of C.B. The court concluded that C.B. was gravely
disabled as defined in Indiana Code section 12-7-2-96. Appellant’s App. p. 8.
C.B. was committed until August 24, 2016 “unless discharged prior.” Id. C.B.
appeals the order of temporary commitment.
Discussion and Decision
[12] C.B.’s appeal of his involuntary commitment is moot because he was
committed to Eskenazi Health until August 24, 2016 “unless discharged prior”
to that date. Appellant’s App. p. 8. In general, “[w]hen a court is unable to
render effective relief to a party, the case is deemed moot and usually
dismissed.” In re J.B., 766 N.E.2d 795, 798 (Ind. Ct. App. 2002) (citing In re
Lawrance, 579 N.E.2d 32, 37 (Ind. 1991)). However, our courts “have long
recognized that a case may be decided on its merits under an exception to the
general rule when the case involves questions of ‘great public interest.’” In re
Lawrance, 579 N.E.2d at 37. Typically, cases falling in the “great public
interest” exception contain issues likely to recur. Id.; see Ind. High Sch. Athletic
Ass'n, Inc. v. Durham, 748 N.E.2d 404, 412 (Ind. Ct. App. 2001) (“Although
Indiana does not require that the issue be capable of repetition, cases falling into
the public interest exception usually involve issues that are likely to recur.”).
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[13] Involuntary commitment of otherwise free individuals in the United States is an
issue of great importance to society. In other countries, mental health
commitments are misused, often for political purposes. Indiana statutory and
case law affirm that the value and dignity of the individual facing commitment
or treatment is of great societal concern. See Ind. Code § 12-26-5-1 (establishing
procedures for seventy-two-hour commitment); Ind. Code § 12-26-6-2(establishing procedures for ninety-day commitment); In re Mental Commitment
of M.P., 510 N.E.2d 645, 646 (Ind. 1987) (noting that the statute granting a
patient the right to refuse treatment “profoundly affirms the value and dignity
of the individual and the commitment of this society to insuring humane
treatment of those we confine”). Because the instant case involves the proof
necessary for involuntary commitment, an issue of great public importance
which will recur, we address it here. See In re J.B., 766 N.E.2d at 798-99.
[14] C.B. claims that the trial court’s order allowing for his involuntary commitment
is not supported by clear and convincing evidence. In Civil Commitment of T.K. v.
Dep’t of Veterans Affairs, 27 N.E.3d 271 (Ind. 2015), our supreme court
explained, “[t]o obtain an involuntary regular commitment of an individual, a
‘petitioner is required to 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.” Id. at 273 (quoting
Ind. Code § 12-26-2-5(e)) (footnote omitted).
[T]he purpose of civil commitment proceedings is dual: to protect
the public and to ensure the rights of the person whose liberty is
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at stake. 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. 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. (internal citations omitted).
[15] C.B. concedes that he is mentally ill but argues that Eskenazi Health did not
present clear and convincing evidence that he was gravely disabled.1 “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.
1
The trial court did not find that C.B. was dangerous to himself or others, only that he was gravely disabled.
Appellant’s App. p. 8.
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Ind. Code § 12-7-2-96. “[D]enial of illness and refusal to medicate, standing
alone, are insufficient to establish grave disability because they do not establish,
by clear and convincing evidence, that such behavior ‘results in the individual’s
inability to function independently.’” T.K., 27 N.E.3d at 276 (quoting I.C. § 12-
7-2-96).
[16] C.B. was not malnourished and did not exhibit poor hygiene when he was
admitted to Eskenazi Health on May 17, 2016. In addition, he has monthly
social security income sufficient to support himself. However, Dr. Beesley
believed that C.B. was homeless because C.B. made several different statements
concerning his lack of housing and his living situation if he were discharged
from the hospital. C.B.’s testimony at the hearing also established that on May
17, 2016, he did not have stable housing. Tr. pp. 34-35.
[17] Dr. Beesley believes that C.B. needs “housing and [a] stable environment where
we could . . . have him actually come back for clinic appointments. And get
subsequent B12 injections.” Tr. p. 18. At the hearing, the doctor expressed
concern that C.B. does not understand his mental illness, cannot function
independently, and would not follow up with his treatment plan. During the
week prior to his May 17, 2016 admission to Eskenazi Health, C.B. was twice
taken to hospitals by police officers. On May 17, the third time C.B. was
transported to a hospital in approximately one week, he was delusional and
lacked housing. At the time he presented, C.B. clearly satisfied both definitions
of grave disability under the statue, when only one is required for commitment.
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To us, it is clear that C.B. needed a structured environment for a moderate
period of time to stabilize his medical and psychiatric conditions and to allow
doctors to properly assess his course of treatment going forward. Judge
Eichholtz’s order was creatively and appropriately limited to solve the problem
before him.
[18] For these reasons, we conclude that clear and convincing evidence supports the
trial court’s finding that C.B. was gravely disabled as defined by Indiana Code
section 12-7-2-96. We therefore affirm the trial court’s order of temporary
commitment.
[19] Affirmed.
Baker, J., and Pyle, J., concur.
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