ATTORNEY FOR APPELLANT: ATTORNEYS FOR APPELLEES:

SHANNON L. ROBINSON JAMES L. WHITLATCH

Shannon Robinson Law KATHRYN DEWEESE

Bloomington, Indiana Bunger & Robertson

Bloomington, Indiana

IN THE

COURT OF APPEALS OF INDIANA

IN THE MATTER OF THE COMMITMENT )

OF E.L., )

)

E.L., )

)

Appellant-Respondent, )

)

vs. ) No. 53A01-1402-MH-66

)

INDIANA UNIVERSITY HEALTH )

BLOOMINGTON HOSPITAL and )

CAREY MAYER, M.D., )

)

Appellees-Petitioners. )

APPEAL FROM THE MONROE CIRCUIT COURT

The Honorable Stephen R. Galvin, Judge

Cause No. 53C07-1401-MH-15

August 11, 2014

MEMORANDUM DECISION – NOT FOR PUBLICATION

MAY, Judge

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.
2

E.L. appeals her involuntary mental health commitment, the order for forced 

medication, and the order that she be transported from a hospital in Bloomington to 

Richmond State Hospital. She asserts multiple issues on appeal which we consolidate 

and restate as:

1. Whether there is sufficient evidence E.L. was a danger to herself or gravely 

disabled as to permit an involuntary mental health commitment; 

2. Whether the trial court erred in issuing an order for forced medication; and

3. Whether the trial court erred in issuing the order to transport.

We affirm.

FACTS AND PROCEDURAL HISTORY

On January 14, 2014, Ashley Risk, a health officer at Indiana University Health 

Bloomington (“IU Health”), filed an Application for Emergency Detention of E.L. Risk 

believed E.L. was suffering from bipolar disorder and was a danger to others because she 

did not “consistently take her medications. She is labile1 and very disruptive and cannot 

be handled in the community.” (App. at 8) (footnote added). Risk believed if E.L. was 

not restrained, she would “continue to not take her medications for her Bipolar disorder, 

potentially increasing her mania. When she is not on her medications she is prone to 

threatening and erratic behavior and excessive spending.” (Id.) Risk’s application was 

 

1 Labile means “readily or continually undergoing chemical, physical, or biological change or breakdown: 

unstable.” Merriam-Webster.com, http://www.merriam-webster.com/dictionary/labile (last visited July 

11, 2014).
3

accompanied by a Physician’s Emergency Statement prepared by Dr. Perry Griffith. Dr. 

Griffith wrote about E.L: 

She is a Bipolar-Manic patient. She is a Manic patient who does not take 

medications and becomes very disruptive/labile and unable to be handled in 

the community. She will not take medications on a consistent basis. 

(Id. at 9.) E.L was then admitted to IU Health for emergency detention.

The next day, Dr. Carey Mayer of IU Health examined E.L. and diagnosed her as 

having “Bipolar I Disorder.” (Id. at 11.) He also found she was “gravely disabled and 

requires continuing care and treatment,” and he recommended she “be detained in this 

facility pending the hearing.” (Id.) 

Later that day, Risk filed a Petition for Involuntary Commitment that stated E.L. 

was suffering from an addiction to narcotics or dangerous drugs in addition to her mental 

illness. Risk added that E.L “is in danger of coming to harm because of her inability to 

provide for food, clothing, shelter, or other essential human needs.” (Id. at 14.) Risk 

wrote that E.L. “exhibits very erratic behavior and poor judgment.” (Id.) 

The Physician’s Statement attached to that Petition for Involuntary Commitment 

was by Dr. Mayer, who stated E.L.’s disorder and addiction to narcotics or dangerous 

drugs disturbed her “thinking, feeling or behavior and impairs her ability to function. 

Specifically: Very manic beh[avior] and symptoms including bizarre behaviors, and poor 

judgement [sic].” (Id. at 15.) Dr. Mayer opined E.L. was in need of care for which 

outpatient treatment would not be adequate. He noted that obtaining treatment on a 

voluntary basis was not appropriate because E.L. “[d]emonstrated poor compliance[.]” 
4

(Id. at 16.) He indicated suitable facilities for her care, treatment and protection were 

Centerstone Community Mental Health Center, Bloomington Hospital, and Psychiatric 

State Hospitals, with Centerstone being the least restrictive environment. He opined that 

E.L.’s treatment needed to be a “2 Year Regular Commitment[.]” (Id. at 17.) 

On January 20, E.L. filed a response to the petition, arguing commitment was 

unnecessary. She indicated she voluntarily sought treatment at both IU Health and 

Centerstone and she asserted she had post-traumatic stress disorder, chronic depression, 

and anxiety. She denied having bipolar disorder, being addicted to narcotics, or 

exhibiting manic behaviors. She also alleged she provided for herself and took all her 

medications. 

The trial court held a hearing on the petition on January 21. At the hearing, Dr. 

Mayer sought a forced medication order to administer Invega Sustenna, Zyprexa, and 

Abilify Maintaina, stating they were all from the same class of medications and their 

risks are outweighed by their benefits. Dr. Mayer testified Centerstone transferred E.L.’s 

treatment because she did not show up several months for her injection of Invega 

Sustenna, a medication for Bipolar Disorder. He stated E.L.’s January admission was her 

third hospitalization in four months and she was manic during her admissions to IU 

Health. Dr. Mayer revealed E.L. threatened Risk with physical assault prior to the 

hearing. In addition, he believed E.L. was falsifying court documents, and she had 

stopped in the middle of the street to yell at people while driving around IU Health. He 
5

testified: “At this time I think it’s in her best interest to go to a state hospital and finally 

get this bipolar manic state treated.” (Tr. at 13.) 

That same day, the trial court entered a commitment order in which it found E.L 

had bipolar disorder, was dangerous to herself and others, and was gravely disabled. The 

order stated IU Health was the appropriate and least restrictive facility for the necessary 

care but, given the short-term stay allowed at IU Health, E.L. could be transferred to a 

state institution for further treatment if necessary. It ordered E.L. to be forcibly 

medicated. 

On February 11, Centerstone wrote a letter to the trial court indicating E.L.’s 

mental status had deteriorated and she needed to be transferred from IU Health to 

Richmond State Hospital for long-term care. Centerstone requested a Transport Order 

for February 17. E.L. filed a motion to reconsider, claiming she had made progress at IU 

Health, Dr. Mayer was to discharge her on February 12, and Centerstone had no direct 

knowledge of her current mental status. E.L. was transported to Richmond.

On February 21, the trial court held a hearing on E.L.’s motion to reconsider. At 

the hearing the court ordered Centerstone, IU Health, and Richmond State Hospital to 

communicate and ensure there was an appropriate treatment plan for E.L. Because the 

three health care providers could not agree on a treatment plan, on March 13, the trial 

court ordered E.L.’s case dismissed and E.L. released from Richmond State Hospital.
6

DISCUSSION AND DECISION

As E.L.’s commitment has been dismissed, this matter is moot. Generally, we 

dismiss cases that are moot, but a moot case may be decided on the merits when it 

involves questions of great public interest that are likely to recur. Golub v. Giles, 814 

N.E.2d 1034, 1036 n.1 (Ind. Ct. App. 2004), trans. denied. “The question of how persons 

subject to involuntary commitment are treated by our trial courts is one of great 

importance to society[,]” therefore, we will address the merits of this case. See id. 

When reviewing a challenge to sufficiency of the evidence with respect to 

commitment proceedings, we must review the evidence in a light most favorable to the 

trial court’s decision and draw all reasonable inferences from that evidence. J.S. v. Ctr. 

for Behavioral Health, 846 N.E.2d 1106, 1111 (Ind. Ct. App. 2006), trans. denied. If a 

commitment order represents a conclusion that a reasonable person could have drawn, we 

will affirm the order, even if other reasonable conclusions are possible. Id. We will not 

reweigh the evidence or judge the credibility of the witnesses. Golub, 814 N.E.2d at 

1038. 

1. Involuntary Mental Health Commitment

To demonstrate that a person should be involuntarily committed, the petitioner 

must 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 the individual 

is appropriate. Ind. Code § 12-26-2-5(e). On that showing, the court may order 

involuntary commitment for a period expected to exceed ninety days. Ind. Code § 12-26-
7

7-1. E.L. is challenging the trial court’s finding that she was either dangerous or gravely 

disabled.2

“Gravely disabled” in this context means 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.

Ind. Code § 12-7-2-96. E.L. argues that she is able to provide food, clothing, shelter, and 

essential needs, but the court could find she was gravely disabled without finding she was 

incapable of providing those needs for herself. See id. 

E.L. had been hospitalized at IU Health in October 2013, November 2013, and 

January 2014. Dr. Mayer believed E.L. did not take her medications and did not seek 

treatment for her bipolar disorder. He noted E.L acted manic during her recent hospital 

admissions, demonstrated poor judgment, and exhibited bizarre behaviors. E.L. was 

frequently angry and threatening, and according to testimony, she threatened Risk with 

physical assault. On multiple occasions, people saw her in the streets around the hospital 

yelling at others. In addition to her physical actions, E.L. told Dr. Mayer that she bought 

many new things, such as three houses and a new car, but her only income was social 

security. The evidence supports the trial court’s determination that E.L. had a substantial 

impairment of judgment, such that her ability to function independently was 

 

2 E.L. does not challenge the determination of her mental illness or the appropriateness of her 

commitment.
8

compromised. See Golub, 814 N.E.2d at 1039 (history of hospitalizations and 

deterioration of behavior was sufficient to demonstrate Golub was gravely disabled).3

2. Forced Medication Order

A patient has the right to refuse treatment, and in order to override the right, a 

petitioner must demonstrate by clear and convincing evidence that:

1) a current and individual medical assessment of the patient’s condition 

has been made; 2) that it resulted in the honest belief of the psychiatrist that 

the medications will be of substantial benefit in treating the condition 

suffered, and not just in controlling the behavior of the individual; 3) and 

that the probable benefits from the proposed treatment outweigh the risk of 

harm to, and personal concerns of, the patient. 

In re Mental Commitment of M.P., 518 N.E.2d 645, 647 (Ind. 1987). In addition, the 

order must limit the time period within which the medications may be administered. Id.

at 648. 

Dr. Mayer made an individual assessment of E.L. and diagnosed her with bipolar 

disorder. He requested she be treated on an on-going basis with Invega Sustenna and 

Abilify Maintena, and the court order immediate-release Zyprexa for use only in the 

event E.L. became too agitated and out of control. According to Dr. Mayer’s testimony, 

the risks of these medications are extremely low and the risks are greatly outweighed by 

the benefits. He noted these medications were to “aggress and align chemical difficulties 

 

3 E.L. also argues she is not dangerous. We need not address that matter, as we affirm based on the trial 

court’s finding that she is gravely disabled. See A.L. v. Wishard Hosp. Servs., Midtown Cmty. Mental 

Health Ctr., 934 N.E.2d 755, 762 (Ind. Ct. App. 2010) (holding because Ind. Code § 12-26-6-1 is written 

in the disjunctive, proof of either being dangerous or gravely disabled is enough to justify involuntary 

commitment). 
9

that we feel are responsible for bipolar disorder.” (Tr. at 9.) Thus, the medications were 

intended not only to decrease E.L.’s symptoms, but also to have a positive impact on her 

condition. He suggested the time limit for the administration of these medications be the 

two-year commitment. That is sufficient evidence to permit a forced medication order. 

See In re Mental Commitment of M.P., 518 N.E.2d at 647-48 (stating the requirements 

needed to override the right to refuse treatment). 

3. Order to Transport

E.L. asserts Centerstone was not her “gatekeeper” under Ind. Code § 12-24-12-10, 

and therefore could not request transport. Her argument is misplaced because she relies 

on article 12-24 of the Indiana Code, which pertains to “State Institutions.” IU Health is 

not a state institution listed in Ind. Code § 12-7-2-184. 

E.L. was committed to IU Health pursuant to Ind. Code art. 12-26, which outlines 

procedures for “Voluntary and Involuntary Treatment of Mentally Ill Individuals.” 

Chapter 11 governs the transfer of an individual and provides an individual committed 

under Ind. Code art. 12-26 may be transferred to a community mental health center or to 

a state institution. Ind. Code § 12-26-11-1. A community mental health center may 

decline to admit an individual being transferred, if certain conditions are met. Ind. Code 

§ 12-26-11-2. If an individual is transferred to a substantially more restrictive 

environment, an administrative hearing must be held within ten days after the transfer. 

Ind. Code § 12-26-11-5. 
10

E.L. does not argue IU Health, Centerstone, and the trial court did not follow the 

procedure outlined in Ind. Code § 12-26-11. IU Health would have ordered E.L. to seek 

outpatient care at Centerstone, as it is the community mental health center in the area. 

However, Centerstone declined to admit E.L. based on the difficulty it had had treating 

E.L. in the past, and Centerstone informed the court E.L. should be transferred to 

Richmond State Hospital. On February 12, 2014, based on Centerstone’s request, the 

trial court ordered E.L. transported to Richmond State Hospital, and the court held a 

hearing within ten days to review that transport. See Ind. Code § 12-26-11-5 (stating a 

court must hold a hearing within ten days of a patient’s transfer to a more restrictive state 

institution). E.L. has not demonstrated error in the trial court’s order to transport her to 

Richmond State Hospital. 

CONCLUSION

The evidence is sufficient to support E.L.’s involuntary mental health commitment 

and forced medication order, and E.L. has not demonstrated error in the procedure by 

which she was transported to Richmond. Accordingly, we affirm.

Affirmed.

KIRSCH, J., and BAILEY, J, concur.