In Re: The Mental Health Commitment of: P.S. v. Good Samaritan Center, LCSW (mem. dec.)

MEMORANDUM DECISION
Pursuant to Ind. Appellate Rule 65(D),
this Memorandum Decision shall not be FILED
regarded as precedent or cited before any Mar 29 2018, 9:13 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
Jacob P. Wahl Curtis T. Hill, Jr.
Jasper, Indiana Attorney General of Indiana
Frances Barrow
Deputy Attorney General
Indianapolis, Indiana
IN THE
COURT OF APPEALS OF INDIANA
In Re: The Mental Health March 29, 2018
Commitment of: P.S., Court of Appeals Case No.
Appellant-Respondent, 51A01-1709-MH-2043
Appeal from the Martin Circuit
v. Court
The Honorable Lynne E. Ellis,
Good Samaritan Center, LCSW Judge
Appellee-Petitioner Trial Court Cause No.
51C01-1706-MH-2
Altice, Judge.
Case Summary
Court of Appeals of Indiana | Memorandum Decision 51A01-1709-MH-2043 | March 29, 2018 Page 1 of 7
[1] P.S. challenges the sufficiency of the evidence supporting her involuntary civil
commitment. In granting the regular commitment, 1 the trial court determined
that P.S. was mentally ill and dangerous to herself and others. On appeal, P.S.
does not challenge the finding of mental illness, but she contends that her
dangerousness was not proven by clear and convincing evidence.
[2] We affirm.
Facts & Procedural History
[3] P.S. has been diagnosed with schizophrenia and has received psychiatric care
from Dr. Michael Cantwell, the medical director of the LaSalle Behavioral
Health Unit at Good Samaritan Hospital (LaSalle Behavioral Health). Over
the years, Dr. Cantwell has met with P.S. on “[i]nnumerable” occasions.
Transcript at 4.
[4] During the early morning hours of June 10, 2017, P.S. called a crisis hotline
and indicated that she had not been taking her prescribed medication and was
having suicidal ideations. During the call, P.S. exhibited “incongruent speech
and mood – disorganized speech.” Appendix at 8. P.S. was directed to seek
immediate assistance at the nearest emergency room. Accordingly, P.S. went
1
There are four types of involuntary civil commitment in Indiana. See Civil Commitment of T.K. v. Dep’t of
Veterans Affairs, 27 N.E.3d 271, 273 n.1 (Ind. 2015) (describing each type). Regular commitment, the type
addressed in this case, is for an indefinite period of time that may exceed ninety days. Id. (citing Ind. Code §
12-26-7 et seq.).
Court of Appeals of Indiana | Memorandum Decision 51A01-1709-MH-2043 | March 29, 2018 Page 2 of 7
to Good Samaritan Hospital and was admitted later that day to LaSalle
Behavioral Health, pursuant to an emergency detention.
[5] Dr. Cantwell performed P.S.’s initial evaluation upon admission. He noted
that P.S. was psychotic and appeared to be under the influence of
amphetamines. P.S. exhibited disorganized thinking and was responding to
visual and auditory hallucinations. Based upon his previous treatment of P.S.,
Dr. Cantwell observed that P.S.’s thinking appeared more impaired than usual.
[6] On the morning of June 12, 2017, P.S. became angry with a nurse and
confronted her at the nurse’s station. P.S. was directed back to her room due to
her yelling obscenities, but P.S. turned around and attempted to strike the
nurse. The nurse and another employee then tried to get P.S. into her room,
while P.S. continued to fight. P.S. threw her elbow into the nurse’s stomach
before security arrived and returned P.S. to her room. P.S. was yelling and
threatened to kill the nurse.
[7] Shortly thereafter, P.S. began repeatedly smashing a trash can against the door
from inside her room. She was yelling and cursing and refused requests to calm
down. Staff members entered the room and physically restrained her, as she
attempted to strike them. P.S. spat in the face of her nurse and threatened to
kill her. P.S. was placed in four-point restraints. Despite this, P.S. refused to
calm down and continued threatening the nurse’s life. Minutes later, P.S.
slipped off her wrist restraints and staff once again had to subdue her as she
fought them and made threats. The wrist restraints were reapplied, along with
Court of Appeals of Indiana | Memorandum Decision 51A01-1709-MH-2043 | March 29, 2018 Page 3 of 7
upper arm restraints. Later that evening, P.S. intentionally urinated all over
herself and the bed and then demanded to have the restraints removed so the
bed sheets could be changed. P.S. became angry upon learning that the sheets
would be changed without removing the restraints.
[8] The following morning, Dr. Cantwell spoke with P.S. and she, once again,
became upset. She attempted to kick him in the stomach but was unable to
make contact due to the doctor’s clipboard blocking her. Thereafter, P.S.
refused to take her scheduled morning medications.
[9] That same day, June 13, 2017, LaSalle Behavioral Health filed a petition for the
involuntary commitment of P.S. based upon her psychiatric disorder and a
belief that she was dangerous as a result of her schizophrenia. Dr. Cantwell’s
physician’s statement was filed with the petition. Dr. Cantwell opined that P.S.
needed inpatient treatment at Evansville State Hospital for a period of more
than ninety days.
[10] The trial court held a commitment hearing on June 15, 2017, at LaSalle
Behavioral Health. Dr. Cantwell was the sole testifying witness. Dr. Cantwell
testified that P.S. suffers from schizophrenia and, at the current time, was
dangerous and still on room restrictions. Dr. Cantwell opined that P.S. needed
structured inpatient treatment with medication and supervision to “make sure
she doesn’t get aggressive with others and end up being hurt herself or hurting
other people” and to prevent her from “using illicit drugs until she understands
that they’re bad for her mental health.” Transcript at 10. Dr. Cantwell
Court of Appeals of Indiana | Memorandum Decision 51A01-1709-MH-2043 | March 29, 2018 Page 4 of 7
indicated that P.S. was currently prescribed Valium and Invega, an anti-
psychotic mood stabilizing medicine.
[11] Additionally, Dr. Cantwell testified about P.S.’s past treatment and indicated,
“we had tremendous difficulty maintaining her” and “she seemed to basically
just challenge us to revoke her [during her past commitment]”. Id. at 13. Given
her “level of aggression and dissatisfaction with…treatment recommendations”,
Dr. Cantwell opined that it would be most appropriate to commit P.S. to
Evansville State Hospital rather than continue her at LaSalle Behavioral
Health. Id. at 14. Based upon his clinical experience, Dr. Cantwell believed
that a commitment longer than ninety days – a regular commitment – would be
required.
[12] At the conclusion of the hearing, the trial court determined that it was in P.S.’s
best interests, as well as the community’s, to grant the request for a regular
commitment – inpatient to exceed ninety days. The court also found that said
commitment should be at a state operated facility, such as Evansville State
Hospital, “so that [P.S.] can be convinced in her mind that those sitting in this
room are not here to harm her, but to help her to the best of everyone’s ability.”
Id. at 19. The court issued an order of commitment that same day in which it
expressly found that P.S. was suffering from a psychiatric disorder and was
dangerous to herself and others.
Discussion & Decision
Court of Appeals of Indiana | Memorandum Decision 51A01-1709-MH-2043 | March 29, 2018 Page 5 of 7
[13] To obtain an involuntary 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.” I.C. § 12-26-2-5(e). Here, the trial court found
that P.S. was mentally ill and dangerous. P.S. does not challenge the mentally
ill finding but asserts, on appeal, that there was insufficient evidence presented
to establish that she was dangerous.
[14] On review, we consider only the probative evidence and the reasonable
inferences supporting the judgment without weighing evidence or assessing
witness credibility. T.K., 27 N.E.3d at 273. We will affirm an involuntary
commitment if a reasonable trier of fact could find the challenged element(s)
proven by clear and convincing evidence. Id.
[15] The issue presented in this case is whether, considering the probative evidence
and reasonable inferences favorable to the judgment, the trial court could have
found by clear and convincing evidence that P.S. was dangerous. “‘Dangerous’
is ‘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.’” Id. at
274 (quoting I.C. § 12-7-2-53).
[16] The record establishes by clear and convincing evidence that P.S. was
dangerous to herself and/or others due to her mental illness. P.S. has
schizophrenia and had previously been under a commitment proceeding and
treated by Dr. Cantwell. Her recent admission to LaSalle Behavioral Health
Court of Appeals of Indiana | Memorandum Decision 51A01-1709-MH-2043 | March 29, 2018 Page 6 of 7
came after she called a crisis hotline and reported suicidal ideations. P.S.
acknowledged that she had not been taking her medication. P.S. then went to
the emergency room as directed. She was psychotic and presented with
disorganized thinking and experiencing visual and auditory hallucinations.
[17] During her emergency commitment to LaSalle Behavioral Health, P.S. became
aggressive and assaultive toward medical staff. She made multiple homicidal
threats and attempted to assault staff several different times. She actually
elbowed a nurse in the stomach on one occasion and spat in a nurse’s face on
another. Additionally, P.S. yelled and cursed, was destructive to property, and
refused to calm down. As a result of her behavior, P.S. was placed on room
restrictions and then four-point restraints. P.S. also refused to take her
medication and did not believe she needed treatment.
[18] LaSalle Behavioral Health could not effectively manage P.S. due to her high
level of aggression. Dr. Cantwell believed a state facility, like Evansville State
Hospital, would be better able to deal with her aggression and help her become
more mentally stable. Accordingly, upon finding that P.S. suffers from mental
illness and is dangerous, the trial court determined that a regular commitment
to a state operated facility was appropriate and the least restrictive environment
suitable for P.S.’s care, treatment, and protection, as well as for the protection
of others. Ample evidence supported the trial court’s judgment.
[19] Judgment affirmed.
[20] Najam, J. and Robb, J., concur.
Court of Appeals of Indiana | Memorandum Decision 51A01-1709-MH-2043 | March 29, 2018 Page 7 of 7