In the Matter of the Civil Commitment of T.D. v. Eskenazi Health Midtown Community Mental Health Center , 40 N.E.3d 507 ( 2015 )

Jul 20 2015, 10:50 am
ATTORNEY FOR APPELLANT ATTORNEY FOR APPELLEE
Deborah Markisohn Rene Wyatt-Foston
Indianapolis, Indiana Indianapolis, Indiana
IN THE
COURT OF APPEALS OF INDIANA
In the Matter of the Civil July 20, 2015
Commitment of T.D., Court of Appeals Case No.
49A05-1411-MH-529
Appellant-Respondent,
Appeal from the Marion Superior
v. Court
Lower Court Cause No.
49D08-1308-MH-16567
Eskenazi Health Midtown
Community Mental Health The Honorable Mark Batties,
Commissioner
Center,
Appellee-Petitioner.
Pyle, Judge.
Statement of the Case
[1] Appellant-Respondent, T.D., appeals the trial court’s order granting Appellee-
Petitioner, Eskenazi Health Midtown Community Mental Health Center’s
(“the Hospital”), application for the emergency detention and involuntary civil
commitment of T.D. based on her mental illness. She argues that the trial court
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erred in ordering her regular commitment because there was insufficient
evidence that she was “gravely disabled,” as the Hospital was required by
statute to prove. The only evidence in the record supporting her commitment
was one isolated incident of unusual behavior, the fact that T.D. lived in a
hotel, her psychiatrist’s recommendation, and her refusal to seek treatment.
Because this did not constitute clear and convincing evidence to support her
involuntary commitment, we reverse the trial court’s decision and remand for
the trial court to vacate the commitment.
We reverse and remand.
Issue
Whether the trial court erred when it ordered T.D.’s regular
commitment.1
Facts
[2] T.D. is a fifty-one year old woman who has been diagnosed with bipolar
disorder and has a history of psychiatric illness and treatment. Beginning on
July 31, 2013, she was on a regular commitment with the Hospital. She was
1
In Civil Commitment of T.K. v. Dep’t of Veterans Affairs, 27 N.E.3d 271, 273 n.1 (Ind. 2015), our Supreme
Court explained:
In Indiana, an adult person may be civilly committed either voluntarily or involuntarily.
Involuntary civil commitment may occur under four circumstances if certain statutorily
regulated conditions are satisfied: (1) “Immediate Detention” by law enforcement for up to
24 hours; (2) “Emergency Detention” for up to 72 hours; (3) “Temporary Commitment”
for up to 90 days; and (4) “Regular Commitment” for an indefinite period of time that may
exceed 90 days.
(Internal citations omitted).
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doing well in treatment and resided at First Home, one of the Hospital’s
residential housing programs. However, on July 22, 2014, the Hospital filed a
notice with the trial court seeking to terminate T.D.’s civil commitment because
she had elected to receive voluntary treatment. On September 4, 2014, the trial
court entered an order terminating T.D.’s commitment.
[3] When T.D.’s commitment ended, she was no longer able to live in the First
Home residential program and went to live in a shelter and then in a hotel.
During this time, T.D. became inconsistent in taking her medication and,
according to her treating physician at the Hospital, Dr. Michael DeMotte (“Dr.
DeMotte”), “her symptoms [] continued to worsen.” (Tr. 8). One night at the
hotel, she was preparing a presentation for a large event in town, and she
flooded her hotel room with water and steam, intending to set off the fire
alarms so that the fire department would come to the hotel and help her prepare
for the event.
[4] Based on this incident, the Hospital filed an application for emergency
detention of T.D. on October 14, 2014. Dr. DeMotte filed a report on the
application on October 16, 2014, and recommended that T.D. be placed on a
regular commitment under INDIANA CODE § 12-26-7 because she was in need
of “custody, care, or treatment in an appropriate facility.” (Tr. 52). He also
reported that T.D. had refused to continue voluntary treatment. The next day,
the trial court set an evidentiary hearing on the matter for October 20, 2014,
and ordered that T.D. be detained pending the hearing.
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[5] Dr. DeMotte testified at the hearing as a psychiatric expert. He stated that T.D.
was a “very pleasant woman” and that he did not believe she was a danger to
herself or others. (Tr. 9). However, he also testified that:
[she] does experience symptoms consistent with mania, including
a euphoric mood. She gets very excited with things; very
grandiose in her plans, large scope projects outside of a scope of
reality. [She] [i]s very distractible in this and her thought process
and decision[-]making frequently kind of get[s] side-tracked from
what she’s working on—rapid speech, racing thoughts, some
impulsivity. All kind of symptoms together in combination
consistent with a manic episode.
(Tr. 10). He explained that while medication did not cure all of T.D.’s
symptoms, she had been doing substantially better while on treatment and her
ability to function had improved. He expressed concerns that since her
previous commitment had been terminated “there ha[d] been more
inconsistency with medications[.]” (Tr. 8). He said that the last time he had
talked to T.D., she had told him that “she no longer wished for voluntary
treatment.” (Tr. 11). Instead, “[s]he felt like she was ready to be discharged
from the hospital and was no longer going to be taking medications unless there
was a subsequent court order for it.” (Tr. 11).
[6] Later in his testimony, Dr. DeMotte also expressed concerns that T.D. had not
“been able to maintain housing” without treatment, whereas she had been able
to maintain it while she was in treatment. (Tr. 11). He said that he thought her
symptoms “impair[ed] her judgment” and reasoning such that “[w]e get into
circumstances such as those when she was brought to the hospital [from] the
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hotel.” (Tr. 11). Based on these concerns, he recommended a regular
commitment and said that he believed a regular commitment transitioning to
outpatient care was the least restrictive option for T.D.
[7] At the conclusion of the hearing, the trial court found that T.D. was “gravely
disabled,” as required by statute, and granted the petition for her regular
commitment. The court also ordered that T.D. take all medications as
prescribed, attend all clinic sessions as scheduled, and maintain her address and
phone number with the court. T.D. now appeals.
Decision
[8] On appeal, T.D. argues that the trial court erred in ordering her commitment
because there was not sufficient evidence to prove that she was “gravely
disabled” as required by statute. See IND. CODE § 12-7-2-96. We have
previously noted that civil commitment is a significant deprivation of liberty
that requires due process protections. Commitment of L.W. v. Midtown Cmty.
Health Ctr., 823 N.E.2d 702, 703 (Ind. Ct. App. 2005). 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. Civil Commitment of T.K.,
27 N.E.3d at 273.
[9] To satisfy the requirements of due process, the facts justifying an involuntary
commitment must be shown by clear and convincing evidence. In re
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Commitment of G.M., 743 N.E.2d 1148, 1151 (Ind. Ct. App. 2001). Clear and
convincing evidence is that 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.’” Civil Commitment of T.K., 27 N.E.3d at 273
(quoting Commitment of J.B. v. Midtown Mental Health Ctr., 581 N.E.2d 448, 450
(Ind. Ct. App. 1991)). It is defined as an intermediate standard of proof greater
than a preponderance of the evidence and less than proof beyond a reasonable
doubt. Lazarus Dep’t Store v. Sutherlin, 544 N.E.2d 513, 527 (Ind. Ct. App.
1989), reh’g denied, trans. denied. In order to be clear and convincing, the
existence of a fact must be highly probable. Id.[10] In reviewing the sufficiency of the evidence supporting a determination
requiring clear and convincing evidence, we will consider only the evidence
favorable to the judgment and all reasonable inferences drawn therefrom.
Commitment of L.W., 823 N.E.2d at 703. We will not reweigh the evidence or
judge the credibility of witnesses. Civil Commitment of T.K., 27 N.E.3d at 273.
[11] In order for a trial court to order a regular commitment, there must be clear and
convincing evidence that an individual is: (1) mentally ill; and (2) either
dangerous or gravely disabled. I.C. § 12-26-7-1. Under INDIANA CODE § 12-7-
2-96, “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:
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(1) is unable to provide for that individual’s food, clothing,
shelter, or other essential 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 sufficient evidence to prove either
that the individual was unable to provide for her basic needs or that her
judgment, reasoning, or behavior was so impaired or deteriorated that it
resulted in her inability to function independently. Civil Commitment of W.S. v.
Eskenazi Health, Midtown Cmty. Health, 23 N.E.3d 29, 34 (Ind. Ct. App. 2014),
trans. denied.
[12] T.D. disputes the trial court’s finding that she was “gravely disabled” such that
she required a regular commitment. Specifically, she asserts that, even though
she suffers from bipolar disorder, the Hospital did not prove, by clear and
convincing evidence, that she was unable to provide for her basic needs or that
her judgment and reasoning were impaired. She notes that there was no
evidence that she lacked personal grooming, was unable to obtain clothing and
dress appropriately, or was malnourished. She also compares her case to K.F. v.
St. Vincent Hosp. & Health Care Ctr., 909 N.E.2d 1063, 1067 (Ind. Ct. App. 2009),
where we reversed a regular commitment based on insufficient evidence.
[13] In response, the Hospital argues that there was sufficient evidence to prove that
T.D. was gravely disabled under both prongs of the definition. First, the
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Hospital asserts that, even though T.D. had housing, she had not been able to
maintain it. Second, the Hospital argues that the hotel incident that led to
T.D.’s emergency detention, as well as Dr. DeMotte’s testimony explaining his
opinions regarding T.D.’s need for treatment, were sufficient to prove that she
was gravely disabled. We disagree.
[14] In Commitment of G.M. and Commitment of J.B., we recently discussed our
Supreme Court’s seminal opinion regarding commitment in Addington v. Texas,
441 U.S. 418 (1979). We explained:
In [Addington] the United States Supreme Court expressed a
strong concern that a decision ordering an involuntary
commitment might be made on the basis of a few isolated
instances of unusual conduct which occurred within a range of
conduct which is generally acceptable. The Court opined that
since 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 G.M., 743 N.E.2d at 1151 (quoting Commitment of J.B., 581
N.E.2d at 450) (discussing Addington).
[15] Our Indiana Supreme Court recently echoed the Addington Court’s caution
against unnecessary commitments in Civil Commitment of T.K. There, our
supreme court disapproved of multiple Court of Appeals decisions affirming
commitments and emphasized that there must be a higher standard of clear and
convincing evidence to support a regular commitment. Civil Commitment of
T.K., 27 N.E.3d at 274. The Court noted that “[t]he clear and convincing
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standard is employed in cases ‘where the wisdom of experience has
demonstrated the need for greater certainty, and where this high standard is
required to sustain claims which have serious social consequences or harsh or
far reaching effects on individuals.’” Id. at 276 (quoting In re G.Y., 904 N.E.2d
1257, 1260 n.1 (Ind. 2009) (additional citation omitted)).
[16] Based on this standard, the Court found that there was insufficient evidence to
support T.K.’s regular commitment, even though he had put flyers on people’s
windshields to inform them of a person’s criminal record, had gone into an
Adult and Child Clinic and started to scream at the staff in a manner that made
them concerned, had acted aggressively towards other patients, was estranged
from all family support, had mentioned use of violence in e-mails and on
Facebook, and had refused treatment. Id. at 274. The supreme court reasoned
that no evidence had been presented to dispute T.K.’s ability to provide food,
clothing or shelter to himself. Id. at 276. Also, there was no evidence that he
was gravely disabled because a refusal to medicate, alone, could not support a
finding of gravely disabled. Id. As for T.K.’s aggression, T.K. “made no
physical outbursts, destroyed no property, [and] did not put himself or others in
actual danger with idiosyncratic behavior[.]” Id. at 277. Notably, the Court did
not find testimony from T.K.’s psychiatrist that T.K. was gravely disabled
dispositive. See id. at 275.
[17] In light of Addington and T.K., we conclude that, here, there was not sufficient
evidence to support T.D.’s regular commitment. While the Hospital argues
that T.D. was unable to maintain shelter, there was no evidence in the record
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that she was unable to pay her hotel bills. We find that T.D.’s decision to live
in a hotel, alone, cannot support a finding of a grave disability because it is
indisputable that a hotel is a form of “shelter.”
[18] As for the second prong of the definition of gravely disabled—concerning a
substantial impairment in judgment, reasoning, or behavior—the primary
evidence in the record regarding this prong was Dr. DeMotte’s testimony that
he believed T.D.’s judgment was impaired when she was not in treatment.
However, the Indiana Code 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:
* * *
(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.
I.C. § 12-7-2-96 (emphasis added). Thus, a part of the definition is that, in
addition to having impaired, the individual “is in danger of coming to harm” as
a result of the impaired judgment. I.C. § 12-7-2-96. Dr. DeMotte testified that
T.D. was a “very pleasant woman” and that he did not believe she was a
danger to herself or others. (Tr. 9).
[19] Further, it is apparent that Dr. DeMotte’s opinion that T.D. was gravely
disabled was based on her alleged failure to maintain housing, her refusal to
seek treatment even though her behavior improved with treatment, and her
incident at the hotel. We have already noted that T.D.’s housing at the hotel
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was not a sufficient basis for a commitment, and in T.K. our supreme court
affirmed that refusal to seek treatment, alone, is not a sufficient basis for
commitment. See id. at 276. As for T.D.’s incident at the hotel, we find that,
while this behavior might have indicated a need for treatment, it was not a
sufficient basis for an ongoing, regular commitment. In Addington, our
Supreme Court warned against the danger of committing individuals based on
“a few isolated instances of unusual conduct.” Addington, 441 U.S. at 427. The
hotel incident was one isolated incident, and, while T.D.’s actions at the hotel
were unusual, she did not harm herself or anyone else.
[20] Because the only evidence the Hospital presented at trial did not constitute clear
and convincing evidence to support T.D.’s commitment, we reverse the trial
court’s decision and remand for the trial court to vacate the regular
commitment.
Reversed and remanded.
Crone, J., and Brown, J., concur.
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