In the Matter of the Civil Commitment of C.C. v. Health and Hospital Corporation d/b/a Eskenazi Health Midtown Community Health (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 Jun 26 2020, 8:51 am
court except for the purpose of establishing
CLERK
the defense of res judicata, collateral Indiana Supreme Court
Court of Appeals
estoppel, or the law of the case. and Tax Court
ATTORNEY FOR APPELLANT ATTORNEYS FOR APPELLEE
Katelyn Bacon Bryan H. Babb
Marion County Public Defender Agency Sarah T. Parks
Indianapolis, Indiana Bose McKinney & Evans, LLP
Indianapolis, Indiana
IN THE
COURT OF APPEALS OF INDIANA
In the Matter of the Civil June 26, 2020
Commitment of C.C., Court of Appeals Case No.
Appellant-Respondent, 19A-MH-2820
Appeal from the Marion Superior
v. Court
The Honorable Melanie Kendrick,
Health and Hospital Corporation Judge Pro Tempore
d/b/a Eskenazi Health Midtown Trial Court Cause No.
Community Health, 49D08-1910-MH-44738
Appellee-Petitioner.
Pyle, Judge.
Court of Appeals of Indiana | Memorandum Decision 19A-MH-2820 | June 26, 2020 Page 1 of 10
Statement of the Case
[1] C.C. (“C.C.”) appeals the trial court’s order for his involuntary temporary
commitment.1 C.C. argues that there was insufficient evidence to support his
temporary commitment because Eskenazi Health Midtown Community Health
(“Eskenazi”) did not prove by clear and convincing evidence that he was a
danger to others or that he was “gravely disabled.” Concluding that there was
sufficient evidence that C.C. was dangerous to others, we affirm.
[2] We affirm.
Issue
Whether there was sufficient evidence to support the trial court’s order
for C.C.’s involuntary temporary civil commitment.
Facts
[3] On October 24, 2019, C.C.’s mother filed an application for emergency
detention seeking to detain C.C. at Eskenazi. C.C.’s mother had concerns
about decompensation in C.C.’s behavior and about delusional thoughts that he
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; “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).
Court of Appeals of Indiana | Memorandum Decision 19A-MH-2820 | June 26, 2020 Page 2 of 10
was having that seemed to be getting worse. A few days later, Eskenazi filed a
Report Following Emergency Detention. This report included a physician’s
statement signed by Dr. Stephen Brandt (“Dr. Brandt”), who diagnosed C.C.
with Schizophrenia. Dr. Brandt also stated that C.C. “ha[d] voiced threats to
harm [a] former professor, his staff, [a] former psychologist associated with
[the] university, ha[d] [sent] text messages stating desire to harm, [which] ha[d]
resulted in several Duty to Warn calls.” (App. Vol. 2 at 18). The trial court
ordered C.C. to be detained for an evidentiary hearing to be held on November
1.
[4] At the evidentiary hearing, Dr. Brian Hart (“Dr. Hart”), the psychiatrist who
treated C.C. while he was on the Eskenazi mental health unit, C.C.’s mother
and father, and C.C. all testified. Dr. Hart explained that when C.C. arrived on
the unit, he was “quite agitated[]” and “very disruptive, physically posturing to
the psychiatric residents.” (Tr. 7). As a result, C.C. was sedated and placed in
a seclusion room. Dr. Hart testified that he had reviewed C.C.’s medical
records, which indicated that C.C. had been treated for mental illness in the
past and had previously been subject to commitment for treatment for his
mental illness. Dr. Hart opined that, based on his observations and review of
C.C.’s medical records, C.C. suffered from Delusional Disorder Persecutory
Type and lacked insight into his mental illness.
[5] Dr. Hart noted that “[C.C.] has displayed a persisting delusional concern about
various members at IU persecuting him, forging his name and he has . . .
repeatedly referred to it as torture and manslaughter[,]” and that this persisting
Court of Appeals of Indiana | Memorandum Decision 19A-MH-2820 | June 26, 2020 Page 3 of 10
persecutory belief had been ongoing since 2014. (Tr. 8). When asked whether
C.C. was dangerous to others, Dr. Hart stated, “I do have concerns that he
could potentially pose a danger to the people at IU that he believes are
persecuting him.” (Tr. 9). Dr. Hart further explained that “the
decompensation of [C.C.’s] condition has resulted in a very hostile relationship
where his mother is beginning to feel threatened. And so[,] I do not know for
her own safety, how much longer she is going to be able to continue to support
him.” (Tr. 10).
[6] C.C.’s mother detailed the course of C.C.’s eleven-year history of mental
illness. She explained that C.C. had had three prior hospitalizations and that
his mental condition had continued to decline. C.C.’s mother testified that she
felt physically threatened by her son. She described an incident that occurred in
the summer of 2019 wherein she and C.C. attended a baseball game. During
the game, C.C. screamed at his mother to the extent that an employee
approached them to ask if everything was okay. As C.C. and his mother left
the game, C.C. screamed at his mother about his delusions, and he took a “very
intimidating posture” with his fists clenched. (Tr. 22).
[7] Following the incident at the baseball game, C.C.’s mother communicated with
C.C. through text messages, occasional calls, and voicemails. C.C. regularly
sent his mother text messages regarding his belief that she was not being honest
with him about her involvement in speaking with I.U. officials. On some days,
C.C.’s mother received “29-30 messages from him that [were] all just – just
discombobul[ated], fragmented sentences, angry, [and] accusatory[.]” (Tr. 25).
Court of Appeals of Indiana | Memorandum Decision 19A-MH-2820 | June 26, 2020 Page 4 of 10
C.C.’s mother testified that she had also received “text messages about [the]
execution of judges that will not help him.” (Tr. 25).
[8] C.C.’s father, a former police officer, further explained C.C.’s mental condition
as follows:
And in particular, there was a group of people at IU that he was –
that were after him, did horrible things to him. One particular . . .
[C.C.] indicated he showed him videos of guns, he drugged him,
he raped him repeatedly, he moved his body, he tortured him, he
inserted wire into his penis and into his chest. And [C.C.] wanted
my help in getting him and other people that had done horrible
things to [C.C.]. And I – I explained to [C.C.], I know his
perception is reality but there was – you know, I needed probable
cause in which I did not have.
(Tr. 33). C.C.’s father stated that he was concerned when C.C. used the word
“executed[,]” explaining that “I do not feel like [C.C.] is a threat to me but I . . .
would not want him in a room with these people mentioned at IU – there [are]
about 5 or 6 of them. I fear that [C.C.], he is like . . . ready to boil over.” (Tr.
34).
[9] C.C. testified that he sends weekly “rage texts” to his mother but claimed that
he would never physically assault her. (Tr. 43). C.C. explained:
Well I just want to restate, [mother] and [father] have said that
there is a decline in our relationship. Our relationship got into a
fight when [mother] kept lying to me about talking to the
university. I do not think dad has lied that much[;] he just doesn’t
want to talk about it. But that is what these nasty text messages
started from. [My mother] would not tell me about a conversation
she had with the university that I might still want to go to the
police over.
Court of Appeals of Indiana | Memorandum Decision 19A-MH-2820 | June 26, 2020 Page 5 of 10
(Tr. 41). C.C. further testified that he “[did] not know” if he needed medication
but that he “[g]enerally[]” knew why he was given medication. (Tr. 43).
[10] At the conclusion of the hearing, the trial court granted the petition for C.C.’s
temporary commitment. The court explained:
At this time the court will find that the evidence today presented
by the doctor, by both parents shows that the respondent is
suffering from a mental illness under Indiana law and is currently
gravely disabled in that there is a substantial impartment of
judgment that is affecting his ability [to] function. And also, that
there is a danger to others. The courts have previously found that
the trial court does not have to wait until an individual commits a
physical act before determining that there is a substantial risk of
harm to others.
(Tr. 46). The court ordered that C.C. take all medications as prescribed, attend
all clinic sessions as scheduled, and maintain his address with the court, as well
as not harass or assault family members or others. C.C. now appeals.
Decision
[11] C.C. contends that there was insufficient evidence to support his involuntary
temporary commitment because Eskenazi did not prove by clear and
convincing evidence that he was dangerous or gravely disabled.2 “‘[T]he
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. v. Dep’t of
2
C.C.’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.
Court of Appeals of Indiana | Memorandum Decision 19A-MH-2820 | June 26, 2020 Page 6 of 10
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.
[12] 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).
[13] 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). Because
Court of Appeals of Indiana | Memorandum Decision 19A-MH-2820 | June 26, 2020 Page 7 of 10
this statute is written in the disjunctive, Eskenazi need only prove that C.C. is
“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.
[14] On appeal, C.C. does not dispute that he is mentally ill. Rather, he argues that
there was insufficient evidence to support the trial court’s conclusion that, as a
result of his mental illness, he is dangerous to others or gravely disabled.
Because we conclude that the evidence is sufficient to show that C.C. was
dangerous to others, we need not address the trial court’s findings regarding
whether C.C. was gravely disabled.
[15] “Because everyone exhibits some abnormal conduct . . . loss of liberty calls for
a showing that the individual suffers from something more serious than is
demonstrated by idiosyncratic behavior. There is no constitutional basis for
confining a mentally ill person who is not dangerous and can live safely in
freedom.” In re Commitment of T.K., 993 N.E.2d 245, 249 (Ind. Ct. App. 2013)
(internal quotation marks and citation omitted), trans. denied. Dangerous is
defined as “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.” I.C. § 12-7-2-53. This court has further explained that:
Dangerousness must be shown by clear and convincing evidence
indicating that the behavior used as an index of a person’s
Court of Appeals of Indiana | Memorandum Decision 19A-MH-2820 | June 26, 2020 Page 8 of 10
dangerousness would not occur but for the person’s mental illness.
This standard is not met by a showing that a person made a
rational and informed decision to engage in conduct that may
have entailed a risk of harm. Instead, the evidence must show that
there is a substantial risk that the person will harm himself [or
others] as a result of a psychiatric disorder which substantially
disturbs the person’s thinking, feeling, or behavior and impairs the
person’s ability to function.
In re Commitment of C.A. v. Center for Mental Health, 776 N.E.2d 1216, 1218 (Ind.
Ct. App. 2002) (quotation marks and citations omitted). Importantly, a trial
court is not required to wait until harm has nearly or actually occurred before
determining that an individual poses a substantial risk to others. C.J. v. Health &
Hosp. Corp. of Marion Cty., 842 N.E.2d 407, 410 (Ind. Ct. App. 2006).
[16] Here, the evidence reveals that a mentally ill C.C. exhibited delusions of
persecution, as evidenced by his belief that he was the victim of rape, torture,
and theft at the hands of I.U. officials. Dr. Hart testified that because of C.C.’s
mental illness, he was concerned that C.C. could pose a danger to the safety of
his mother and I.U. officials. In addition, Dr. Hart stated that he had reviewed
C.C.’s medical records, which indicated that C.C. had been treated for mental
illness in the past and that, when C.C. was admitted to Eskenazi, he was
“agitated[]” and “very disruptive, physically posturing to the psychiatric
residents.” (Tr. 7). Dr. Hart testified that C.C. did not have any insight into his
mental illness and does not believe that he is suffering from any symptoms.
[17] C.C.’s mother testified that C.C. had been verbally assaultive and that she had
felt physically threatened him. She explained that C.C. regularly sent her text
messages regarding his belief that she was not being honest with him about her
Court of Appeals of Indiana | Memorandum Decision 19A-MH-2820 | June 26, 2020 Page 9 of 10
involvement in speaking with I.U. officials. She further testified, which was
corroborated by testimony from C.C.’s father, that C.C. had discussed the
execution of officials at I.U. and judges who will not help him. Furthermore,
C.C.’s father, a former police officer, expressed his concern for the safety of the
individuals at I.U., stating that he “would not want [C.C.] in a room” with
those individuals. (Tr. 34).
[18] Although C.C. has no history of violence upon another individual, this does not
preclude the trial court from finding that C.C. was dangerous to others. See
T.K., 993 N.E.2d at 250 (concluding that evidence of threats and hostility
towards hospital staff and T.K.’s denial that he suffers from mental illness
established that T.K. was a danger to others). Because the evidence in the
record before us supports the trial court’s determination that C.C. is a danger to
others, we affirm the trial court’s commitment order.
[19] Affirmed.
Bradford, C.J., and Baker, J., concur.
Court of Appeals of Indiana | Memorandum Decision 19A-MH-2820 | June 26, 2020 Page 10 of 10