In Re: The Involuntary Commitment of Y.K. v. Deaconess Hospital, April Toelle and Selah House (mem. dec.) ( 2020 )

MEMORANDUM DECISION
Pursuant to Ind. Appellate Rule 65(D),
this Memorandum Decision shall not be FILED
regarded as precedent or cited before any Dec 16 2020, 9:51 am
court except for the purpose of establishing CLERK
the defense of res judicata, collateral Indiana Supreme Court
Court of Appeals
and Tax Court
estoppel, or the law of the case.
ATTORNEY FOR APPELLANT
Katherine N. Worman
Evansville, Indiana
IN THE
COURT OF APPEALS OF INDIANA
In Re: The Involuntary December 16, 2020
Commitment of Y.K., Court of Appeals Case No.
Appellant, 20A-MH-1116
Appeal from the Vanderburgh
v. Superior Court
The Honorable Leslie Shively,
Deaconess Hospital, April Toelle Judge
and Selah House, The Honorable Jill Marcrum,
Appellee. Magistrate
Trial Court Cause No.
82D05-2001-MH-431
Pyle, Judge.
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Statement of the Case
[1] Y.K. (“Y.K.”) appeals the trial court’s order extending her involuntary
temporary commitment.1 Y.K. argues that there was insufficient evidence to
support the extension of her temporary involuntary commitment because Selah
House (“Selah House”) did not prove by clear and convincing evidence that she
was mentally ill and a danger to herself or gravely disabled. Concluding that
there was sufficient evidence that Y.K. was both mentally ill and gravely
disabled, we affirm the trial court’s order.
[2] We affirm.
Issue
Whether there was sufficient evidence to support the trial court’s order
extending Y.K.’s involuntary temporary civil commitment.
Facts
[3] On January 29, 2020, Y.K. was admitted to the Deaconess Midtown
emergency room (“Deaconess”) due to swelling in her lower extremities. Upon
1
In Civil Commitment of T.K. v. Dep’t of Veterans Affairs, 27 N.E.3d 271, 273 n.1 (Ind. 2015), the Indiana
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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admission, Y.K. weighed 66 pounds. Deaconess determined that Y.K.’s
swelling had developed due to complications associated with malnutrition.
That same day, a Deaconess physician filed an application for emergency
detention, which was approved by the trial court.
[4] On February 4, 2020, Deaconess filed a petition for approval of attending
physician’s treatment plan, a physician’s statement, and a report following
emergency detention. The physician’s statement was signed by Dr. Hemapriya
Reddy (“Dr. Reddy”), who had diagnosed Y.K. with an eating and psychiatric
disorder, specifically, Anorexia Nervosa. Dr. Reddy also stated that Y.K.’s
eating disorder was “causing harm to [her]self [,] causing severe malnutrition,
and complications[.]” (App. Vol. 2 at 26). The next day, Deaconess filed a
petition for temporary commitment.
[5] On February 6, 2020, the trial court held a hearing on the petition for
temporary commitment. Dr. Reddy, Y.K.’s father, and Y.K. testified at the
hearing. Dr. Reddy testified that he had diagnosed Y.K. with Anorexia. He
explained the complications Y.K. had already developed, including fluid
accumulation in her lower extremities, belly, and around her heart. Dr. Reddy
also detailed the potential prognosis of Y.K.’s continued malnutrition, which
included debility and possibly death. Dr. Reddy opined that Anorexia is both a
physical and a mental condition, but that it is “mostly a psychiatric thing
because it’s all in their mind.” (Tr. 9-10).
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[6] Dr. Reddy believed that Y.K.’s diagnosis would “definitely impair” her ability
to function outside of a hospital setting. (Tr. 10). Dr. Reddy further explained
that Y.K.’s treatment plan included her being transferred to the I.U. Medical
Center, which possesses a unit that specializes in eating disorders. Dr. Reddy
also noted that Y.K.’s current weight was 73 pounds, and that given her age
and height, a normal weight would be “around 105, 110 pounds[.]” (Tr. 18).
[7] During Y.K.’s testimony, she disagreed with her Anorexia diagnosis and
explained that she had a passion for health and taking care of her body.
According to Y.K., she did not need counseling on eating disorders or mental
health because she was aware of what she was thinking and doing. Following
Y.K.’s testimony, the trial court granted the petition for Y.K.’s temporary
commitment with approval for transfer to the I.U. Medical Center. On
February 7, Y.K. was transferred to the I.U. Medical Center.
[8] In April 2020, Y.K. was transferred to Selah House. On May 5, 2020, Selah
House filed a physician’s statement and report requesting extension of
temporary commitment. The physician’s statement was signed by Dr. Thomas
Scales (“Dr. Scales”), who had performed Y.K.’s psychiatric assessment at
Selah House and diagnosed her with a psychiatric disorder called “Avoidant
Restrictive Food Intake Disorder[.]” (App. Vol. 2 at 45). A petition for
extension of temporary commitment was also filed on May 5.
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[9] The trial court held a hearing on the extension petition on May 6, wherein Dr.
Scales and Y.K. testified.2 Dr. Scales explained that he was a board-certified
psychiatrist, and that in addition to performing Y.K.’s psychiatric assessment,
he had examined her two other times. Dr. Scales stated that Y.K. weighed 84
pounds when she was admitted to Selah House. He described Y.K. as “very
underweight[]” and explained that her weight at that point was “approximately
60% of her ideal body weight[.]” (Tr. 28). Dr. Scales explained that Y.K.
suffered from Avoidant Restrictive Food Intake Disorder, which he described
as follows:
[It] is characterized by (indiscernible) of food or aversion to
(indiscernible) consequences of eating certain foods or by avoiding
some certain sensory characteristics of food that kind of results in
not being able to meet [the] body’s energy needs. It kind of
manifests by weight loss, needing to be on nutritional
supplements, either gastric feedings[.]
***
It’s a disorder in eating pattern that’s characterized by concern
about the adverse of consequences of eating certain foods.
(Indiscernible) based on the sensory characteristics that results in
weight loss and the body’s inability or failure to meet its basic
energy requirements. (Indiscernible) loss can be severe. It’s
characterized by being dependent on supplements, nutritional
supplements, or [i]nternal or naso-gastric tube feeding.
2
This hearing was conducted remotely, and there were technical difficulties throughout the hearing,
consisting of the participants’ speech fading in and out. This resulted in several instances of indiscernible
testimony in the transcript.
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(Tr. 25, 28). Dr. Scales noted that Y.K. did not have a medical condition or
food allergy that caused her low weight. Dr. Scales did explain that Y.K. had
complained of experiencing acid reflux when eating certain food.
[10] Dr. Scales described Y.K.’s recommended treatment plan, which included
meeting with a dietician, a therapist, group psychotherapy, psychiatric care, and
medical care. Dr. Scales explained:
I believe that being in a residential or i[n]patient level of care is the
appropriate level of care given the medical complications that can
occur during the process of re-feeding, and also to provide enough
support for her to get the nutrition that she needs. She needs three
meals a day and two snacks a day. Or actually, perhaps three
snacks a day. And at home or a (indiscernible) structured
environment she wouldn’t get the support that she would need, the
nutritional support and the psychological support, and
(indiscernible) support. In an inpatient setting[,] she has access to
nurses 24/7 and she’s able to get her vitals checked daily and she
will have her blood drawn at least twice a week (indiscernible)
necessarily. It’s hard to do that – this level of care is hard to do on
the less structured [environment].
(Tr. 33-34).
[11] Dr. Scales also expressed that his primary concern was Y.K.’s physical and
mental health. Dr. Scales noted that while Y.K. did have some insight into her
mental illness, he believed that Y.K. had trouble “understanding . . . the risk of
[not] having a structured environment [and] that she [is] currently [in] the
process of the healing.” (Tr. 36). When asked whether Y.K. presented a
substantial risk that she may harm herself, Dr. Scales answered as follows:
Yes, I think if she (indiscernible) doesn’t have adequate nutrition,
doesn’t take in enough nutrition she could harm herself and
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experience some complications that she experienced before, like
the pericardial effusion (indiscernible). She also has osteoporosis
that could worsen, too. She could fall and fracture a bone. So[,]
there is a serious risk of (indiscernible) receiving treatment.
(Tr. 36). When asked whether he believed Y.K. could provide for herself, Dr.
Scales answered “[n]o, I don’t think she – she’s not caring for her basic
nutritional needs. She’s not providing for herself in providing basic nutritional
needs.” (Tr. 37). He further explained that Y.K.’s failure to meet her
nutritional needs was “due to her diagnosis of avoidant restrictive food intake
disorder.” (Tr. 37). Dr. Scales concluded that based on Y.K.’s mental illness
and medical history, Y.K. was gravely disabled.
[12] Y.K. testified that prior to her hospitalizations, she had eaten a plant-based diet.
She explained that she had experienced digestive issues that had prevented her
from eating a variety of foods. Y.K. also stated that the cause of her weight loss
and admission to the emergency room was not her fault. Y.K. explained that
she had a passion for taking care of her body and that she did not have body
image issues. Thereafter, the trial court found that Y.K. suffered from a mental
illness and was a danger to herself and gravely disabled and ordered that Y.K.’s
temporary commitment be extended. Y.K. now appeals.
Decision
[13] At the outset, we note that an appellee’s brief was not filed in this appeal.
Indiana Appellate Rule 45(D) provides in relevant part that an appellee’s failure
to timely file an appellee’s brief may result in reversal of the trial court on the
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appellant’s showing of prima facie error. “When the Appellee fails to submit an
answer brief ‘we need not undertake the burden of developing an argument on
the [A]ppellee’s behalf.’” Front Row Motors, LLC v. Jones, 5 N.E.3d 753, 758
(Ind. 2014) (quoting Trinity Homes, LLC v. Fang, 848 N.E.2d 1065, 1068 (Ind.
2006)). “Instead ‘we will reverse the trial court’s judgment if the [A]ppellant’s
brief presents a case of prima facie error.’” Front Row Motors, 5 N.E.3d at 758
(quoting Trinity Homes, 848 N.E.2d at 1068). “Prima facie error in this context
is defined as, at first sight, on first appearance, or on the face of it.” Front Row
Motors, 5 N.E.3d at 758 (internal quotation marks and citation omitted).
However, even in light of this relaxed standard, we still have the obligation to
correctly apply the law to the facts in the record to determine whether reversal
is required. WindGate Properties., LLC v. Sanders, 93 N.E.3d 809, 813 (Ind. Ct.
App. 2018).
[14] Y.K. contends that there was insufficient evidence to support the extension of
her involuntary temporary commitment. Specifically, she disputes the trial
court’s determination that she was: (1) mentally ill; and (2) a danger to herself
or gravely disabled. We will address each argument in turn.3
[15] In Indiana, “‘[t]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.’” T.K.
3
Y.K.’s 90-day temporary commitment has expired, and therefore, the issue is moot. However, the issue is
one of great importance that is likely to recur. Accordingly, we will address the issue on its merits. See Golub
v. Giles, 814 N.E.2d 1034, 1036 n.1 (Ind. Ct. App. 2004), trans. denied.
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v. Dep’t of Veterans Affairs, 27 N.E.3d 271, 273 (Ind. 2015) (quoting 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. Id.[16] To satisfy the requirements of due process, the facts justifying an involuntary
commitment must be shown by clear and convincing evidence. In re
Commitment of G.M., 743 N.E.2d 1148, 1151 (Ind. Ct. App. 2001). Clear and
convincing evidence is defined as an intermediate standard of proof greater than
a preponderance of the evidence and less than proof beyond a reasonable doubt.
T.D. v. Eskenazi Midtown Cmty. Mental Health Ctr., 40 N.E.3d 507, 510 (Ind. Ct.
App. 2015). In order to be clear and convincing, the existence of a fact must be
highly probable. Id. When we review the sufficiency of the evidence
supporting an involuntary commitment, we 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.”
T.K., 27 N.E.3d at 273 (quotation and citation omitted).
[17] To obtain an involuntary commitment, the 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.” IND. CODE § 12-26-2-5(e) (format altered).
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1. Mental Illness
[18] For purposes of involuntary commitment, mental illness is defined as a
psychiatric disorder that: (A) substantially disturbs an individual’s thinking,
feeling, or behavior; and (B) impairs the individual’s ability to function. I.C. §
12-7-2-130. Turning to Y.K.’s first contention, she does not challenge her
psychiatric disorder diagnosis. Rather, she argues that her disorder neither
disturbs her thinking, feeling, or behavior nor impairs her ability to function.
We disagree.
[19] Dr. Scales testified that he had performed a psychiatric assessment of Y.K. and
had evaluated her two other times. Dr. Scales diagnosed Y.K. with a
psychiatric disorder, specifically Avoidant Restrictive Food Intake Disorder.
This disorder is characterized by “avoiding some certain sensory characteristics
of food that kind of results in not being able to meet [the] body’s energy needs.”
(Tr. 25). According to Dr. Scales, Y.K.’s disorder impaired her ability to
function because she was not meeting her basic and essential nutritional needs.
[20] From this evidence, the trial court could have reasonably found that there was
clear and convincing evidence that Y.K. was mentally ill because she had a
psychiatric disorder, Avoidant Restrictive Food Intake Disorder, which was
substantially disturbing her thinking, feeling, behavior and ability to function.
Y.K.’s argument to the contrary is an invitation to reweigh the evidence, which
we may not do. See T.K., 27 N.E.3d at 273.
2. Gravely Disabled
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[21] Y.K. next challenges the extension of her temporary commitment by arguing
that there was insufficient evidence that she was dangerous or gravely disabled.
As noted above, to obtain an involuntary commitment, the 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) (format
altered). Because this statute is written in the disjunctive, we will affirm if the
evidence establishes that Y.K. was “either dangerous or gravely disabled.” Id.
(emphasis added); see also M.Z. v. Clarian Health Partners, 829 N.E.2d 634, 637
(Ind. Ct. App. 2005) (“It is important to note that in order to carry its burden of
proof, Clarian only had to prove that M.Z. was either gravely disabled or
dangerous. It did not have to prove both of these elements.”) (emphasis in
original), trans. denied. We conclude that the evidence is sufficient to show that
Y.K. was gravely disabled, and therefore, we need not address the trial court’s
findings regarding whether Y.K. was dangerous.
[22] 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.
I.C. § 12-7-2-96. As we have often noted, because this statute is written in the
disjunctive, a trial court’s finding of grave disability survives if we find that
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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 is so
impaired or deteriorated that it results 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.
[23] Y.K. asserts that the evidence does not show that she was “gravely disabled.”
Specifically, she argues that there was no evidence presented that she was
“unable to provide herself with clothing, shelter, or other essential human
needs[,]” including food. (Y.K.’s Br. 13).
[24] However, the record reveals that there was evidence that Y.K. had failed to
provide herself with food or meet other essential needs. When Y.K. was first
admitted to a hospital, she weighed 66 pounds and exhibited swelling in her
lower extremities. The hospital determined that Y.K.’s swelling had developed
due to complications associated with malnutrition. After three months of
inpatient treatment, Y.K.’s weight had increased to 84 pounds. However, Dr.
Scales explained that Y.K. continued to be “very underweight[]” and that her
weight was “approximately 60% of her ideal body weight[.]” (Tr. 28). Dr.
Scales opined that Y.K.’s eating disorder had “resulted in her having significant
weight loss and having actually really severe medical complications[.]” (Tr.
26). When asked whether he believed Y.K. could provide for herself, Dr.
Scales explained that Y.K. was not caring for herself by providing basic
nutritional needs. Furthermore, although Dr. Scales stated that Y.K. had some
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insight into her mental illness, he explained that he did not believe that she fully
grasped the severity of the risks associated with her eating disorder.
[25] Based on the above, we conclude that there was sufficient evidence that as a
result of Y.K.’s mental illness, she was gravely disabled for purposes of her
involuntary temporary commitment. Therefore, we affirm the trial court’s
commitment extension order.
[26] Affirmed.
Kirsch, J., and Tavitas, J., concur.
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