Court of Appeals of Indiana | Memorandum Decision 19A

- MH

- 2330 | April 29, 2020 Page 1 of 10



### MEMORANDUM DECISION Pursuant to Ind. Appellate Rule 65(D), this Memorandum Decision shall not be regarded as precedent or cited before any court except for the purpose of establishing the defense of res judicata, collateral estoppel, or the law of the case.

A TTORNEY FOR A PPELLANT Christopher Kunz Marion County Public Defender Indianapolis, Indiana A TTORNEY S FOR A PPELLEE Jenny R. Buchheit Stephen E. Reynolds Sean T. Dewey Ice Miller, LLP Indianapolis, Indiana



### I N T H E 

# COURT OF APPEALS OF INDIANA

In the Matter of the Civil Commitment of M.T. Appellant

- Respondent

,

v. 

### Options Behavioral Health Systems , Appellee

- P etitioner. April 29, 2020 Court of Appeals Ca se No. 19A

- MH

- 2330 Appeal from the Marion Superior Court The Honorable Steven R. Eichholtz, Judge The Honorable Melanie Kendrick, Magistrate Trial Court Cause No. 49D08

- 1908

- MH

- 34159

Pyle , Judge
.Court of Appeals of Indiana | Memorandum Decision 19A

- MH

- 2330 | April 29, 2020 Page 2 of 10 

### Statement of the Case

[1] M.T. (“M.T.”) appeals the trial court’s order for his involuntary regular civil commitment. 1 M.T. argues that there was in sufficient ev idence to support his regular commitment because Options Behavioral Health System s (“Options”) did not prove by clear and convincing evidence that he was “gravely disabled,” as defined by I ND I ANA C ODE § 12

- 7

- 2

- 96. Concluding that there was sufficient evidence , we affirm

[2] We affirm.



### Issue

Whether there was sufficient evidence to support the trial court’s order for M.T.’s involuntary regular civil commitment. 

### Facts

[3] I n early August 2019, thirty

- nine

- year - old M.T. traveled from Indianapolis to Chicago. While in Chicago, M.T. spent his days at the library and his nights sleeping on the streets. Eventually, M.T. called his brother , V.L., and mother

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 i nvoluntarily. Involuntary civil commitment may occur under for 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

- 2330 | April 29, 2020 Page 3 of 10

and informed them where he wa s. V.L. and M.T.’s mother drove to Chicago to pick up M. T. As they drove back to Indianapolis , M.T. explained that “the voices” had told him to go to Chicago and to not take his medication. (Tr. 20). V.L. and M.T.’s mother encouraged M.T. to go to the hospital after his Chicago trip, but he refused.

[4] On August 15, 2019, M.T. was found walking in the middle of a busy street with his eyes closed, saying that he was a rapist and a murdere r
. The police took him to Community Hospital, and a Community Hospital physician filed an appli cation for emergency detention. The next day, M.T. was transferred to Options. Options then filed a Report Following Emergency Detention. This report included a Physician’s statement signed by Dr. Richard Payne (“Dr. Payne”) , who stated that M.T. was suffering from Schizophrenia and Bipolar Disorder and was gravely disabled. The trial court ordered M.T. to be detained for an e videntiary hearing to be held on August 22.

[5] At the evidentiary hearing, Dr. Payne and V.L. testified. Dr. Payne testified that he wa s a psychiatrist with Options , and that M.T. ha d a diagnosis of Paranoid Schizophrenia . Dr. Payne testified that M.T. “presents [as] very paranoid. He talks to himself when others, you know, when there is n o one there[,]” and that M.T. wa s “very guarded.” (Tr. 7). Dr. Payne explained that upon his admission to Options, M.T. was expressing suicidal ideations. According to Dr. Payne , M.T. had refused to eat or drink water for several days , and his refusal was “severe” and stemmed from his mental illness. (Tr. 9). Dr. Payne testified that he was concerned about M.T. because of hisCourt of Appeals of Indiana | Memorandum Decision 19A

- MH

- 2330 | April 29, 2020 Page 4 of 10

Paranoid Schizophrenia . Specifically, Dr. Payne explained that “[M.T.] believes that these things are so real [,] ” and that he will take action to alleviate his paranoia. (Tr. 9). Further, that action may involve harming “ the people who he feel s may be after him or to end his own life.” (Tr. 9

- 10 ).

[6] Dr. Payne further testified that M.T. had no insight into his mental ill ness. He explained that t his lack of insight affected M.T.’s ability to seek care or take medication . Further, Dr. Payne stated that M.T. believe d he did not need medication , and that this belief has led to multiple hospital admissions. According to Dr. Payne, M.T. had been hospitalized ten times since 2013. Dr. Payne believed that M.T. had been hospitalized five times in 2019 , and that , prior to being hospitalized i n August 2019, M.T.’s most recent hospitalization was in February 2019. As a result of the February hospitalization, M.T. was temporarily committed ; it terminated in May 2019

.

[7] When asked how M.T.’s Paranoid Schizophrenia impacts his judgment or ability to function independently, Dr. Pa yne explained that M.T. was unable to make simple decisions, did not currently have a job, and would not be able to hold a job because “he could not even respond to simple tasks that we were trying to get him to do .” (Tr. 10). Dr. Payne stated that based on his treatment of M.T., he believe d that M.T. wa s “[g]ravely disabled and severely disabled []”
and that “[t]his is someone [he] wo r r [ies ] about extremely.” (Tr. 11). When asked if M.T. presented a substantial risk of harming himself, Dr. Payne answered in the affirmative

. Dr. Payne explained that a regular commitment was necessary because :Court of Appeals of Indiana | Memorandum Decision 19A

- MH

- 2330 | April 29, 2020 Page 5 of 10

[ M.T. ] has all of these hospitalizations just this year and he has had over

– a

bout ten since two thousand and thirteen. You do not get too many chances with a schizophrenic. Usually, to get well in that time

– usually something happens. You know, a lot of them end up dead or they get so frightened and paranoid they feel that they have to attack you or attack random people. (Tr. 12). Dr. Payne testified that, if the regular commitment were granted, he planned to put M.T. on a long acting injectable medication

. He further recommended that M.T. remain inpatient “for several months at first ” and then be “ tra nsfer [red] to a state facility where he c ould be treated longer because he just ha d not gotten well.” (Tr. 13

- 14). Dr. Payne indicated that with treatment, M.T.’s prognosis would be “[s]ubstantially better than it [was] now[,]” and without t reatment, “his prognosis [ wa s ] very poor [.]” (Tr. 14).

[8] M.T.’s older brother , V.L., testified about M.T.’s trip to Chicago when he spent his days at the library and nights sleeping on the street. V.L. expresse d concerns regarding whether M.T. c ould independently support himself. He explained that M.T. had previously lived in an apartment but had been evicted because he did not pay his rent. V.L. further explained that their mother had allowed M.T. to live wit h her, but that M.T. did not want to do so, preferring instead to stay at the Wheeler Mission or to sleep on the streets. When asked whether his brother had been taking his medication or had other wise been compliant with his treatment, V.L. testified that M.T. had not. Later in V.L.’s testimony, he explained that in 2005, M.T. had claimed that voices had told M.T. to jump out of a three

- story

- window, which he acted on

. Additionally, in 2016, M.T. claimed the voices told him to kill himself, leading M.T. to driveCourt of Appeals of Indiana | Memorandum Decision 19A

- MH

- 2330 | April 29, 2020 Page 6 of 10

into a highway median. V.L. stated that his brother’s illness and suicidal behavior w ere “a vicious cycle.” (Tr. 2 1 ).

[9] At the conclusion of the hearing, the trial court found that M.T. was “gravely disabled,” and granted th e petition for his regular commit ment. As a basis for its decision, the court explained as follows :

The court finds that the testimony and evidence today from the doctor as well as the brother and the fact that [M.T.] was on a previous commitment this yea r in February

– it expired in May. And there ha [ve] been at least two if not three possible admissions since then. There have been five total admissions this year alone. Shows that would be the least restrictive alternative at this point is a regular co mmitment as a temporary commitment gave [M.T.] an opportunity to follow up with treatment on his own and he did not do so. The multiple admissions show that

– or also show that he is

– has a substantial impairment in his judgment that is leading to an obv ious deterioration in his ability to function as well as care for himself. Testimony that he has not been eating in addition to again, the multiple admissions recently show that the respondent is gravely disabled. The court will grant a regular commitmen t at this point and find it is the least restrictive. (Tr. 25). The court also ordered that M.T. take all medications as prescribed, attend all clinic sessions as scheduled, and maintain his address and phone number with the court. M.T. now appeals. 

### Opinion

[10] On appeal, M.T. contends that there was insufficient evidence to support his involuntary regular commitment because Options did not prove by clear and convincing evidence that he was “gravely disabled

. ” “ ‘ [T]he purpose of civilCourt of Appeals of Indiana | Memorandum Decision 19A

- MH

- 2330 | April 29, 2020 Page 7 of 10

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 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 con sequences that accompany such physical confinement, a proceeding for an involunt ary civil commitment is subject to due process requirements. Id

.

[11] 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 5 07, 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 probati ve evidence and the reasonable inferences supporting it , without weighing evidence or assessing witness credibility, a reasonabl e 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).

[12] To obtain an involuntary commitment, a petitioner is “required to prove by clear and convincing evidence that: (1) the individual is mentally ill and eitherCourt of Appeals of Indiana | Memorandum Decision 19A

- MH

- 2330 | April 29, 2020 Page 8 of 10

dan gerous or gravely disabled; and (2) detention or commitment of that indi vidual is appropriate.” I ND

. C ODE § 12

- 26

- 2

- 5(e) (format altered). Thus, here, Options had the burden of proving subsections (1) and (2) by clear and convincing evidence.

[13] M.T. does not dispute that he is mentally ill. Rather, he argues that there was
i nsufficient evidence to support the trial court’s conclusion that, as a result of his mental illness, he is gravely disabled. 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 dete rioration of that individual’s judgment, reasoning, or behavior that results in the individual’s inability to function independently.

I ND

. C ODE § 12

- 7

- 2

- 96

. B ecause 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 his basic needs or that his judgment, reasoning, or behavior i s so impaired or deteriorated that it result s in his inability to function independently. Civil Commitment of W.S. v

. Esk enazi Health, Midtown Cmty. Health , 23 N.E.3d 29, 34 (Ind. Ct. App. 2014), trans

. denied

.

[14] M.T. asserts that the evidence does not sh ow that he was “gravely disabled

. ” Specifically, he argues that the court “stated two reason s for find ing that M.T. was gravely disabled

– he has had multiple hospital admissions and has notCourt of Appeals of Indiana | Memorandum Decision 19A

- MH

- 2330 | April 29, 2020 Page 9 of 10

been ea t ing [] ” and that neither one of these reasons supported a finding of grave disab ility

. (M.T.’s Br. 9). In response, Options argues that there was sufficient evidence that M.T. was “gravely disabled.” We agree with Options.

[15] The record reveals that there was evidence that M.T.’s judgment, reasoning, or behavior was so impaired or deteriorated that it results in his inability to function independ ently. Specifically, M.T. was found walking in the middle of a busy street with his eyes closed, saying that he was a rapist and a murdere r
. Dr. Payne testified that M.T. suffers from Paranoid Schizophrenia and that he

wa s “very paranoid[]” and “ guarded.” (Tr. 7). The doctor explained that when
M.T. arrived at Options, M.T. expressed suicidal ideations , and refused to eat or drink water for several days

. Dr. P ayne explained that M.T.’s refusal was “severe” and stemmed from his mental illness. (Tr. 9). When asked how M.T.’s Paranoid Schizophrenia impacts his judgment or ability to function independently, Dr. Payne explained that M.T. was unable to make simple decisions and would not be able to hold a job because he could not respond to simple tasks

.

[16] Additionally , there was evidence that M.T. was unable to provide for his basic needs. Dr. Payne indicated that M.T. had no insight into his mental illness,
and tha t this lack of insight affected M.T.’s ability to seek care or take medication because he did not believe he needed medication. Furthermore, V.L. explained that he did not believe that M.T. could independently support himself because M.T. previously had lived in an apartment but had been evicted because he did not pay his rent. V.L. further explained that their motherCourt of Appeals of Indiana | Memorandum Decision 19A

- MH

- 2330 | April 29, 2020 Page 10 of 10

allowed M.T. to live with her, but that M.T. did not want to do so, preferring to stay at the Wheeler Mission or to sleep on the streets.

[17] Based upon the record, we conclude that clear and convincing evidence supports the trial court’s determination that M.T. was gravely disabled for purposes of his involuntary regular commitment. See , e
. g ., Golub v. Giles , 814 N.E.2d 1034, 1039 (Ind. Ct. App. 2004) (patient’s refusal to accept his mental illness and cooperate with his treatment, paired with his history of mental health issues and destructive behavior, was sufficient to support a finding of grave disability), trans

. denied

. Accordingly, we affirm the trial court’s
commitment order.

[18] Affirmed.

B radford, C.J., and Baker, J., concur.