In the Matter of the Civil Commitment of A.M., A.M. v. Community Health Network, Inc.

FILED
Dec 13 2018, 8:39 am
CLERK
Indiana Supreme Court
Court of Appeals
and Tax Court
ATTORNEYS FOR APPELLANT ATTORNEYS FOR APPELLEE
Valerie K. Boots Jenny R. Buchheit
Marion County Public Defender Agency Stephen E. Reynolds
– Appellate Division Gregory W. Pottorff
Indianapolis, Indiana Ice Miller, LLP
Joel M. Schumm Indianapolis, Indiana
Indianapolis, Indiana
IN THE
COURT OF APPEALS OF INDIANA
In the Matter of the Civil December 13, 2018
Commitment of A.M., Court of Appeals Case No.
18A-MH-636
A.M.
Appeal from the Marion Superior
Appellant-Respondent, Court
v. The Honorable Kelly M. Scanlan,
Commissioner
Community Health Network, Trial Court Cause No.
Inc., 49D08-1802-MH-7271
Appellee-Petitioner.
Mathias, Judge.
[1] A.M. appeals the Marion Superior Court’s order of temporary involuntary
commitment. A.M. raises two arguments, which we restate as:
I. Whether the order is defective because it was only signed by the master
commissioner, and not the trial judge; and,
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II. Whether the temporary involuntary commitment was supported by clear
and convincing evidence of grave disability.
[2] We affirm.
Facts and Procedural History
[3] A.M. is a forty-eight-year-old woman who suffers from a schizophrenia
spectrum disorder.1 On or about February 21, 2018, A.M. was in the lobby of
an Indianapolis Hampton Inn and was exhibiting disorganized behavior and
thoughts. After concluding that A.M. needed medical treatment, a law
enforcement officer transported her to Community North Hospital (“the
Hospital”).
[4] A.M. was examined by Dr. Shilpa Puri, and on February 22, 2018, the Hospital
filed an Application for Emergency Detention. The Hospital alleged that A.M.
was suffering from a psychiatric disorder “which substantially disturbs her
thinking, feeling or behavior and impairs her ability of function.” Appellant’s
App. p. 12. The Hospital specifically alleged that A.M. was either dangerous to
herself or others or gravely disabled “as evidenced by disorganized behavior
and thoughts and paranoid delusions. [A.M.] was very disheveled and
malodorous upon admission indicating that she has not been taking care of her
hygiene. She has been refusing all medication and labs.” Id.
1
A.M. was previously hospitalized in 2015 for acute agitation and suicidal ideations. Tr. p. 6.
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[5] Five days later, the Hospital filed a “Report Following Emergency Detention”
and alleged that A.M. was suffering from “unspecified schizophrenia spectrum
and other psychotic disorder and is dangerous[.]” Id. at 14. The Hospital
recommended that A.M. be detained pending the hearing. The accompanying
physician’s statement alleged that A.M. was both dangerous to herself and
others and gravely disabled. Dr. Puri believed that A.M. was “in need of
custody, care, or treatment in an appropriate facility,” that “[o]utpatient
treatment would be adequate,” and “[c]ommitment would not be necessary if
this person were taking medication.” Id. at 17. Dr. Puri advised that A.M.
refused to begin voluntary treatment. Therefore, the Hospital requested a
temporary involuntary commitment not to exceed ninety days.
[6] The commitment hearing was held on March 1, 2018, before Commissioner
Scanlan. Dr. Puri testified that when A.M. was admitted to the Hospital, she
“was jumping from topic to topic” and displayed “very disorganized behavior.”
Tr. p. 6.
She would throw a bunch of food and jigsaw piece[s] all over her
room. She wasn’t showering, taking care of her hygiene. She was
expressing grandiose delusions about her being on a neuro-
science committee for Eli Lilly. Traveling to different countries
for conferences. As well as paranoid delusions about the police
being after her.
Id.
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[7] Dr. Puri examined A.M. eleven times from February 22 to March 1, 2018,
including the morning of the hearing. She diagnosed A.M. with unspecified
schizophrenia based on the following observations:
[T]he patient was displaying very disorganized thoughts, jumping
from topic to topic, no clear condition there. Disorganized
behavior including the jigsaw puzzles and food being spread out
all over her room. She would intermittently yell on the unit, for
no apparent reason. She has been seen talking to her food. Been
seen talking to herself, having auditory hallucinations as well as
those grandiose delusions and the paranoid delusions that I
mentioned earlier.
Id. at 7. Dr. Puri testified that A.M. lacks insight into her mental illness, which
“affect[s] her ability to seek care” and take medications. Id. at 8. Dr. Puri stated
that A.M. missed sixteen doses of her medication. Id. Dr. Puri does not believe
that A.M. will take medication unless she is hospitalized.
[8] Dr. Puri also testified that A.M. is not able to provide herself with food,
clothing and shelter.2 She was not aware whether A.M. had income or a place
to live prior to her hospital admission, and A.M. was not employed. A.M.’s
appearance is “disheveled,” and she does not shower or brush her teeth. Id. at
2
A.M. testified that she makes money from writing and she has friends and family that allow her to live with
them. Tr. p. 18. She also testified that she gives herself a sponge bath but will not shower at the hospital
because the water is cold. Id. at 19.
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8–9. To the doctor’s knowledge, A.M. does not have anyone who can assist her
in meeting her basic needs.
[9] The following exchange occurred at the hearing concerning the extent of
A.M.’s mental illness:
Question: Does Miss M suffer a substantial impairment or an
obvious deterioration of her judgment, reasoning or behavior that
results in her inability to function independently?
Dr. Puri: Yes.
Question: And how does the unspecified schizophrenia affect her
ability to function independently?
Dr. Puri: [She] is unable to take care of her hygiene. She hasn’t
been showering; very malodorous. Unable to provide shelter for
her as to my knowledge.
Question: So if she were released, you . . . think that based on her
behavior that she wouldn’t be able to function?
Dr. Puri: I don’t believe so.
Question: Okay. And are there any other behaviors that she’s
exhibited that support your opinion that you haven’t mentioned?
Dr. Puri: Those are the ones.
Question: And based on your treatment of Miss M, is she gravely
disabled?
Dr. Puri: Yes.
Question: Is this opinion based on her chronic mental illness?
Dr. Puri: Yes.
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Question: Based on your examination, treatment and contact
with Miss M. do you believe that she presents a substantial risk
that she will harm herself?
Dr. Puri: Yes.
Question: And what is the basis for your opinion?
Dr. Puri: She has been displaying disorganized thoughts and
behaviors as well as auditory hallucinations. So based on that she
poses a potential risk for her listening to the auditory
hallucinations and potentially harming herself.
Id. at 9–10.
[10] Dr. Puri also testified that there is a substantial risk that A.M. will harm others
based on an incident with the nursing staff at the Hospital on February 26.
Specifically, A.M. was agitated because the “nursing staff told her to not bring
food into her room. She started yelling and pacing the hallways. She required
PRN medication[,] including Haldol and Ativan to deescalate.” Id. at 11. Dr.
Puri also stated that A.M.’s “paranoid delusions about the cops being after [her]
there is some risk of her [h]arming other people.” Id. at 12. If A.M. thinks other
people are trying to harm her, she “might actually harm other people.” Id.
However, to Dr. Puri’s knowledge, A.M. has never physically harmed anyone.
Id. at 17.
[11] Finally, Dr. Puri stated that a temporary commitment was necessary for A.M.’s
treatment to improve her condition because A.M. “believes that she is not
suffering from any sort of psychiatric condition so she has been refusing all
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medications scheduled for her.” Id. at 12. A.M. specifically refused to take
certain anti-psychotic medications that Dr. Puri recommended to her. Id. at 14.
[12] The trial court found that A.M. suffers from a mental illness, i.e. unspecified
schizophrenia spectrum disorder, and that she is gravely disabled. Specifically,
the court stated that A.M. “has not identified any income that she has or any
particular place for her to stay and she is demonstrating a substantial
impairment or obvious deterioration of her judgment, reasoning and behavior
that has affected her ability to function independently.” Id. at 29–30. Therefore,
the court ordered an involuntary, temporary commitment until May 20, 2018,
unless discharged prior.
[13] The commissioner issued the findings and signed the March 1, 2018 order
involuntarily committing A.M. The trial judge did not sign the order. The trial
judge issued an “approval order” on March 2 under a separate cause number
approving of all of the orders entered by his commissioner on March 1, 2018.
The approval order is not listed in the Chronological Case Summary (“CCS”)
of these proceedings.
[14] A.M. now appeals.3
3
This court held oral argument in this case on November 19, 2018, at Hamilton Southeastern High School in
Fishers, Indiana. We thank the staff, administration, and students for their gracious hospitality, and
particularly extend our gratitude to Janet Chandler and Mary Armstrong. We also commend counsel for the
excellence of their oral and written advocacy.
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The Unsigned Order
[15] A.M. argues that we should temporarily stay this case and remand to the trial
court for further proceedings because the temporary involuntary commitment
order was signed only by a commissioner and not the judge.4 On the date the
order was issued, Indiana law expressly barred Commissioner Scanlan from
entering a final appealable order in this case. See Ind. Code § 33-23-5-8.5
However, the Hospital argues that A.M. waived her challenge to the validity of
the commitment order because she did not object to the commitment order
before pursuing her appeal.
[16] “‘[I]t has been the long-standing policy of [the Indiana Supreme Court] to view
the authority of the officer appointed to try a case not as affecting the
jurisdiction of the court’ –and so ‘the failure of a party to object at trial to the
authority of a court officer to enter a final appealable order waives the issue for
appeal.’” In re Adoption of I.B., 32 N.E.3d 1164, 1173 n.6 (Ind. 2015) (quoting
Floyd v. State, 650 N.E.2d 28, 32 (Ind. 1994)); see also City of Indianapolis v. Hicks,
4
This has been a recurring issue in this trial court. However, in the following memorandum decisions, our
court concluded that the patient waived the issue by failing to timely object that the commitment order was
not signed by the trial judge. See C.H. v. Options Behavioral Health System, 18A-MH-638, 2018 WL 5943704(Ind. Ct. App. Nov. 14, 2018) (three consolidated appeals), A.L. v. St. Vincent Hosp. & Health Care Ctr., 18A-
MH-1147, 2018 WL 4907037 (Ind. Ct. App. Oct. 10, 2018) and D.H. v. Eskenazi Health, 18A-MH-635, 2018
WL 4558304 (Ind. Ct. App. Sept. 19, 2018).
5
Effective July 1, 2018, the statute was amended to remove the limitation regarding magistrates (and, thus,
commissioners) from entering a final appealable order. However, Indiana Code section 33-23-5-9(a) still
requires that the trial court “enter the final order” in instances such as this.
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932 N.E.2d 227, 231 (Ind. Ct. App. 2010) (stating that “defects in the authority
of a court officer, as opposed to the jurisdiction of the trial court itself, to enter a
final order will be waived if not raised through a timely objection”), trans.
denied. “[A]ny objection to the authority of an adjudicative officer must be
raised at the first instance the irregularity occurs, or at least within such time as
the tribunal is able to remedy the defect.” Hicks, 932 N.E.2d at 231.
[17] Therefore, when a party seeks to object that a magistrate or commissioner, but
not the judge, signed the final order, the party must file a motion to correct
error or other similar motion before the notice of appeal is filed. However, this
is inconsistent with Trial Rule 59(A) which provides that a motion to correct
error is a not a prerequisite for appeal unless the party seeks to address newly
discovered material evidence or a claim that a jury verdict is excessive or
inadequate. The rule explicitly states that “[a]ll other issues and grounds for
appeal appropriately preserved during trial may be initially addressed in the
appellate brief.” Ind. Trial Rule 59(A).
[18] We acknowledge this inconsistency, but we are constrained to follow precedent
and conclude that A.M. waived her argument that the order is defective because
it was not signed by a judge.6 See also In the Matter of A.M., 959 N.E.2d 832, 834
n.1 (Ind. Ct. App. 2011) (concluding that A.M. waived the issue because she
6
Because we conclude that the issue is waived, we decline to address the Hospital’s argument that A.M.’s
argument is moot because Indiana Code section 33-23-5-8 was amended effective July 1, 2018.
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failed to timely object that the commitment order was signed only by the
magistrate), disapproved of on other grounds by P.B. v. Evansville State Hospital, 90
N.E.3d 1199 (Ind. Ct. App. 2017); but see L.J. v. Health and Hospital Corp., 2018
WL 5075089, Slip op. at 3 n.4 (Ind. Ct. App. Oct. 18, 2018) (declining to
address the waiver argument).
Evidence of Grave Disability
[19] A.M. also argues that the Hospital failed to present clear and convincing
evidence that she is gravely disabled.7 In this regard, our court has previously
observed that “the purpose of civil commitment proceedings is dual: to protect
the public and to ensure the rights of the person whose liberty is at stake.” 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. 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.
7
A.M.’s 90-day temporary commitment has expired, but her appeal is not moot. See M.Z. v. Clarian Health
Partners, 829 N.E.2d 634, 637 (Ind. Ct. App. 2005), trans. denied.
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Civil Commitment of T.K. v. Dep’t of Veterans Affairs, 27 N.E.3d 271, 273 (Ind.
2015) (internal citations and quotations omitted).
[20] The Hospital was required to prove by clear and convincing evidence that A.M.
is mentally ill and either dangerous or gravely disabled and that detention or
commitment of A.M. is appropriate. See Ind. Code § 12-26-2-5(e). When we
review the sufficiency of the evidence to support a civil commitment, “‘an
appellate court 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.’” Commitment of M.E. v. Dep’t of
Veterans Affairs, 64 N.E.3d 855, 861 (Ind. Ct. App. 2016) (quoting T.K., 27
N.E.3d at 273) (internal quotation omitted)), disapproved of on other grounds by
A.A. v. Eskenazi Health/Midtown CMHC, 97 N.E.3d 606, 611 (Ind. 2018)). Clear
and convincing evidence requires proof that the existence of a fact is “highly
probable.” Id. “‘There is no constitutional basis for confining a mentally ill
person who is not dangerous and can live safely in freedom.’” Id. (quoting
Commitment of J.B. v. Midtown Mental Health Ctr., 581 N.E.2d 448, 451 (Ind. Ct.
App. 1991)).
[21] Indiana Code section 12-7-2-96 defines “gravely disabled” as:
[A] condition in which an individual, as a result of mental illness,
is in danger of coming to harm because the individual:
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(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.
Because this statute is written in the disjunctive, a trial court’s finding of grave
disability survives if we find that there was clear and convincing evidence to
prove either that the individual was unable to provide for his basic needs or that
her judgment, reasoning, or behavior was so impaired or deteriorated that it
resulted in her inability to function independently. Commitment of B.J. v. Eskenazi
Hosp./Midtown CMHC, 67 N.E.3d 1034, 1039 (Ind. Ct. App. 2016).
[22] It is important to recall that denial of mental illness and refusal to medicate,
standing alone, are legally insufficient to establish grave disability because they
do not establish by clear and convincing evidence that the individual is unable
to function independently. See T.K., 27 N.E.3d at 276. Moreover, since
everyone exhibits some abnormal conduct at one time or another, “loss of
liberty [through a commitment] calls for a showing that the individual suffers
from something more serious than is demonstrated by idiosyncratic behavior.”
Addington v. Texas, 441 U.S. 418, 427 (1979).
[23] A.M. concedes that she is mentally ill but argues that the Hospital failed to
prove by clear and convincing evidence that she is “in danger of coming to
harm” as a result of her mental illness. Appellant’s Br. at 10 (citing I.C. § 12-7-
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2-96). Specifically, A.M. claims that her refusal to shower is not clear and
convincing evidence that she is in danger of coming to harm. A.M. also asserts
that the hospital failed to prove that she is unable to provide food, clothing and
shelter for herself. A.M. concedes that she “may not be functioning optimally or
ideally,” but “‘unusual decisions’ or ‘certain behaviors characteristic of a person
with [a mental illness]” are not sufficient to uphold an involuntary commitment
based on grave disability.” Id. at 13 (quoting In the Matter of the Commitment of
K.F. v. St. Vincent Hosp. and Health Care Ctr., 909 N.E.2d 1063, 1067 (Ind. Ct.
App. 2009), disapproved on other grounds by T.K., 27 N.E.3d at 274).
[24] The Hospital argues that Dr. Puri’s testimony is sufficient to meet the clear and
convincing evidence standard. Dr. Puri testified that as a result of her mental
illness, A.M. is unable to function independently. Tr. p. 9. A.M. admitted that
she lacks income and lives a transient lifestyle. A.M. does not properly care for
her hygiene, and she throws and talks to her food. A.M. denies her mental
illness and refuses to take her medication. Importantly, although the last two
factors are, standing alone, insufficient to establish grave disability, they may
still be considered in determining whether A.M. is gravely disabled.
[25] A.M. attempts to analogize her case to other cases reversing temporary
commitments because there was insufficient evidence to establish that the
patient was gravely disabled. In T.K., there was no evidence presented to
dispute the patient’s ability to provide food, clothing and shelter for himself
because he was employed, owned two vehicles and rented his own home. 27
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N.E.3d at 276. In M.E., the patient was able to function independently, ate
properly, lived alone in his rented apartment and was able to clothe himself,
and the petitioning hospital’s reliance on M.E.’s past behavior could not be
utilized at the time of the commitment hearing to establish grave disability. 64
N.E.3d at 862–63. Finally, in K.F., the petitioning hospital presented only the
doctor’s equivocal testimony concerning whether the patient was able to
function independently, there was no concern about her ability to care for her
basic needs, and K.F.’s husband and son testified that she could function
independently. 909 N.E.2d at 1066–67.
[26] In contrast, A.M. is admittedly transient and does not have a stable income or
shelter. And Dr. Puri testified that if A.M. were released from the Hospital, she
would not be able to function independently. Also, and quite importantly, the
Hospital was required to forcibly administer two psychotropic medications to
de-escalate A.M.’s behavior while under her emergency commitment. Under
these facts and circumstances, we conclude that the Hospital presented clear
and convincing evidence that as a result of her mental illness, A.M. is gravely
disabled because she is in danger of coming to harm from her inability to
function independently.
Conclusion
[27] Under controlling precedent, A.M. waived her claim that the temporary
involuntary commitment order is defective, because she did not raise the
argument in the trial court. Further, we affirm the trial court’s commitment
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order because we conclude that the order is supported by clear and convincing
evidence of grave disability.
[28] Affirmed.
Bradford, J., and Altice, J., concur.
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