Court of Appeals of Indiana | Opinion 18A-MH-636 | December 13, 2018 Page 1 of 15

ATTORNEYS FOR APPELLANT

Valerie K. Boots

Marion County Public Defender Agency 

– Appellate Division

Indianapolis, Indiana

Joel M. Schumm

Indianapolis, Indiana

ATTORNEYS FOR APPELLEE

Jenny R. Buchheit

Stephen E. Reynolds

Gregory W. Pottorff

Ice Miller, LLP

Indianapolis, Indiana 

IN THE

COURT OF APPEALS OF INDIANA

In the Matter of the Civil 

Commitment of A.M.,

A.M.

Appellant-Respondent,

v.

Community Health Network, 

Inc.,

Appellee-Petitioner.

December 13, 2018

Court of Appeals Case No.

18A-MH-636

Appeal from the Marion Superior 

Court 

The Honorable Kelly M. Scanlan, 

Commissioner

Trial Court Cause No.

49D08-1802-MH-7271

Mathias, Judge.

[1] A.M. appeals the Marion Superior Court’s order of temporary involuntary 

commitment. A.M. raises two arguments, which we restate as:

I. Whether the order is defective because it was only signed by the master 

commissioner, and not the trial judge; and,
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II. Whether the temporary involuntary commitment was supported by clear 

and convincing evidence of grave disability. 

[2] We affirm.

Facts and Procedural History

[3] A.M. is a forty-eight-year-old woman who suffers from a schizophrenia 

spectrum disorder.1 On or about February 21, 2018, A.M. was in the lobby of 

an Indianapolis Hampton Inn and was exhibiting disorganized behavior and 

thoughts. After concluding that A.M. needed medical treatment, a law 

enforcement officer transported her to Community North Hospital (“the 

Hospital”). 

[4] A.M. was examined by Dr. Shilpa Puri, and on February 22, 2018, the Hospital 

filed an Application for Emergency Detention. The Hospital alleged that A.M. 

was suffering from a psychiatric disorder “which substantially disturbs her 

thinking, feeling or behavior and impairs her ability of function.” Appellant’s 

App. p. 12. The Hospital specifically alleged that A.M. was either dangerous to 

herself or others or gravely disabled “as evidenced by disorganized behavior 

and thoughts and paranoid delusions. [A.M.] was very disheveled and 

malodorous upon admission indicating that she has not been taking care of her 

hygiene. She has been refusing all medication and labs.” Id.

 

1 A.M. was previously hospitalized in 2015 for acute agitation and suicidal ideations. Tr. p. 6.
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[5] Five days later, the Hospital filed a “Report Following Emergency Detention” 

and alleged that A.M. was suffering from “unspecified schizophrenia spectrum 

and other psychotic disorder and is dangerous[.]” Id. at 14. The Hospital 

recommended that A.M. be detained pending the hearing. The accompanying 

physician’s statement alleged that A.M. was both dangerous to herself and 

others and gravely disabled. Dr. Puri believed that A.M. was “in need of 

custody, care, or treatment in an appropriate facility,” that “[o]utpatient 

treatment would be adequate,” and “[c]ommitment would not be necessary if 

this person were taking medication.” Id. at 17. Dr. Puri advised that A.M. 

refused to begin voluntary treatment. Therefore, the Hospital requested a 

temporary involuntary commitment not to exceed ninety days.

[6] The commitment hearing was held on March 1, 2018, before Commissioner

Scanlan. Dr. Puri testified that when A.M. was admitted to the Hospital, she 

“was jumping from topic to topic” and displayed “very disorganized behavior.” 

Tr. p. 6. 

She would throw a bunch of food and jigsaw piece[s] all over her 

room. She wasn’t showering, taking care of her hygiene. She was 

expressing grandiose delusions about her being on a neuroscience committee for Eli Lilly. Traveling to different countries 

for conferences. As well as paranoid delusions about the police 

being after her.

Id.
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[7] Dr. Puri examined A.M. eleven times from February 22 to March 1, 2018, 

including the morning of the hearing. She diagnosed A.M. with unspecified 

schizophrenia based on the following observations:

[T]he patient was displaying very disorganized thoughts, jumping 

from topic to topic, no clear condition there. Disorganized 

behavior including the jigsaw puzzles and food being spread out 

all over her room. She would intermittently yell on the unit, for 

no apparent reason. She has been seen talking to her food. Been 

seen talking to herself, having auditory hallucinations as well as 

those grandiose delusions and the paranoid delusions that I 

mentioned earlier.

Id. at 7. Dr. Puri testified that A.M. lacks insight into her mental illness, which 

“affect[s] her ability to seek care” and take medications. Id. at 8. Dr. Puri stated 

that A.M. missed sixteen doses of her medication. Id. Dr. Puri does not believe 

that A.M. will take medication unless she is hospitalized.

[8] Dr. Puri also testified that A.M. is not able to provide herself with food, 

clothing and shelter.2 She was not aware whether A.M. had income or a place 

to live prior to her hospital admission, and A.M. was not employed. A.M.’s 

appearance is “disheveled,” and she does not shower or brush her teeth. Id. at

 

2 A.M. testified that she makes money from writing and she has friends and family that allow her to live with 

them. Tr. p. 18. She also testified that she gives herself a sponge bath but will not shower at the hospital 

because the water is cold. Id. at 19. 
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8–9. To the doctor’s knowledge, A.M. does not have anyone who can assist her 

in meeting her basic needs.

[9] The following exchange occurred at the hearing concerning the extent of 

A.M.’s mental illness:

Question: Does Miss M suffer a substantial impairment or an 

obvious deterioration of her judgment, reasoning or behavior that 

results in her inability to function independently?

Dr. Puri: Yes.

Question: And how does the unspecified schizophrenia affect her 

ability to function independently?

Dr. Puri: [She] is unable to take care of her hygiene. She hasn’t 

been showering; very malodorous. Unable to provide shelter for 

her as to my knowledge.

Question: So if she were released, you . . . think that based on her 

behavior that she wouldn’t be able to function?

Dr. Puri: I don’t believe so.

Question: Okay. And are there any other behaviors that she’s 

exhibited that support your opinion that you haven’t mentioned?

Dr. Puri: Those are the ones.

Question: And based on your treatment of Miss M, is she gravely 

disabled?

Dr. Puri: Yes.

Question: Is this opinion based on her chronic mental illness?

Dr. Puri: Yes.
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Question: Based on your examination, treatment and contact 

with Miss M. do you believe that she presents a substantial risk 

that she will harm herself?

Dr. Puri: Yes.

Question: And what is the basis for your opinion?

Dr. Puri: She has been displaying disorganized thoughts and 

behaviors as well as auditory hallucinations. So based on that she 

poses a potential risk for her listening to the auditory 

hallucinations and potentially harming herself.

Id. at 9–10.

[10] Dr. Puri also testified that there is a substantial risk that A.M. will harm others 

based on an incident with the nursing staff at the Hospital on February 26. 

Specifically, A.M. was agitated because the “nursing staff told her to not bring 

food into her room. She started yelling and pacing the hallways. She required 

PRN medication[,] including Haldol and Ativan to deescalate.” Id. at 11. Dr. 

Puri also stated that A.M.’s “paranoid delusions about the cops being after [her] 

there is some risk of her [h]arming other people.” Id. at 12. If A.M. thinks other 

people are trying to harm her, she “might actually harm other people.” Id.

However, to Dr. Puri’s knowledge, A.M. has never physically harmed anyone. 

Id. at 17.

[11] Finally, Dr. Puri stated that a temporary commitment was necessary for A.M.’s 

treatment to improve her condition because A.M. “believes that she is not 

suffering from any sort of psychiatric condition so she has been refusing all 
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medications scheduled for her.” Id. at 12. A.M. specifically refused to take 

certain anti-psychotic medications that Dr. Puri recommended to her. Id. at 14.

[12] The trial court found that A.M. suffers from a mental illness, i.e. unspecified 

schizophrenia spectrum disorder, and that she is gravely disabled. Specifically, 

the court stated that A.M. “has not identified any income that she has or any 

particular place for her to stay and she is demonstrating a substantial 

impairment or obvious deterioration of her judgment, reasoning and behavior 

that has affected her ability to function independently.” Id. at 29–30. Therefore, 

the court ordered an involuntary, temporary commitment until May 20, 2018, 

unless discharged prior.

[13] The commissioner issued the findings and signed the March 1, 2018 order 

involuntarily committing A.M. The trial judge did not sign the order. The trial 

judge issued an “approval order” on March 2 under a separate cause number 

approving of all of the orders entered by his commissioner on March 1, 2018. 

The approval order is not listed in the Chronological Case Summary (“CCS”) 

of these proceedings. 

[14] A.M. now appeals.

3

 

3

This court held oral argument in this case on November 19, 2018, at Hamilton Southeastern High School in 

Fishers, Indiana. We thank the staff, administration, and students for their gracious hospitality, and 

particularly extend our gratitude to Janet Chandler and Mary Armstrong. We also commend counsel for the 

excellence of their oral and written advocacy.
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The Unsigned Order

[15] A.M. argues that we should temporarily stay this case and remand to the trial 

court for further proceedings because the temporary involuntary commitment 

order was signed only by a commissioner and not the judge.4 On the date the

order was issued, Indiana law expressly barred Commissioner Scanlan from 

entering a final appealable order in this case. See Ind. Code § 33-23-5-8.

5

However, the Hospital argues that A.M. waived her challenge to the validity of 

the commitment order because she did not object to the commitment order 

before pursuing her appeal. 

[16] “‘[I]t has been the long-standing policy of [the Indiana Supreme Court] to view 

the authority of the officer appointed to try a case not as affecting the 

jurisdiction of the court’ –and so ‘the failure of a party to object at trial to the 

authority of a court officer to enter a final appealable order waives the issue for 

appeal.’” In re Adoption of I.B., 32 N.E.3d 1164, 1173 n.6 (Ind. 2015) (quoting 

Floyd v. State, 650 N.E.2d 28, 32 (Ind. 1994)); see also City of Indianapolis v. Hicks, 

 

4 This has been a recurring issue in this trial court. However, in the following memorandum decisions, our 

court concluded that the patient waived the issue by failing to timely object that the commitment order was 

not signed by the trial judge. See C.H. v. Options Behavioral Health System, 18A-MH-638, 2018 WL 5943704

(Ind. Ct. App. Nov. 14, 2018) (three consolidated appeals), A.L. v. St. Vincent Hosp. & Health Care Ctr., 18AMH-1147, 2018 WL 4907037 (Ind. Ct. App. Oct. 10, 2018) and D.H. v. Eskenazi Health, 18A-MH-635, 2018 

WL 4558304 (Ind. Ct. App. Sept. 19, 2018). 

5 Effective July 1, 2018, the statute was amended to remove the limitation regarding magistrates (and, thus, 

commissioners) from entering a final appealable order. However, Indiana Code section 33-23-5-9(a) still 

requires that the trial court “enter the final order” in instances such as this.
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932 N.E.2d 227, 231 (Ind. Ct. App. 2010) (stating that “defects in the authority 

of a court officer, as opposed to the jurisdiction of the trial court itself, to enter a 

final order will be waived if not raised through a timely objection”), trans. 

denied. “[A]ny objection to the authority of an adjudicative officer must be 

raised at the first instance the irregularity occurs, or at least within such time as 

the tribunal is able to remedy the defect.” Hicks, 932 N.E.2d at 231.

[17] Therefore, when a party seeks to object that a magistrate or commissioner, but 

not the judge, signed the final order, the party must file a motion to correct 

error or other similar motion before the notice of appeal is filed. However, this 

is inconsistent with Trial Rule 59(A) which provides that a motion to correct 

error is a not a prerequisite for appeal unless the party seeks to address newly 

discovered material evidence or a claim that a jury verdict is excessive or 

inadequate. The rule explicitly states that “[a]ll other issues and grounds for 

appeal appropriately preserved during trial may be initially addressed in the 

appellate brief.” Ind. Trial Rule 59(A). 

[18] We acknowledge this inconsistency, but we are constrained to follow precedent 

and conclude that A.M. waived her argument that the order is defective because 

it was not signed by a judge.6 See also In the Matter of A.M., 959 N.E.2d 832, 834 

n.1 (Ind. Ct. App. 2011) (concluding that A.M. waived the issue because she 

 

6 Because we conclude that the issue is waived, we decline to address the Hospital’s argument that A.M.’s 

argument is moot because Indiana Code section 33-23-5-8 was amended effective July 1, 2018.
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failed to timely object that the commitment order was signed only by the 

magistrate), disapproved of on other grounds by P.B. v. Evansville State Hospital, 90 

N.E.3d 1199 (Ind. Ct. App. 2017); but see L.J. v. Health and Hospital Corp., 2018 

WL 5075089, Slip op. at 3 n.4 (Ind. Ct. App. Oct. 18, 2018) (declining to 

address the waiver argument). 

Evidence of Grave Disability

[19] A.M. also argues that the Hospital failed to present clear and convincing 

evidence that she is gravely disabled.7 In this regard, our court has previously 

observed that “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.” 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. To satisfy 

the requirements of due process, the facts justifying an

involuntary commitment must be shown by clear and convincing 

evidence . . . [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.

 

7 A.M.’s 90-day temporary commitment has expired, but her appeal is not moot. See M.Z. v. Clarian Health 

Partners, 829 N.E.2d 634, 637 (Ind. Ct. App. 2005), trans. denied.
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Civil Commitment of T.K. v. Dep’t of Veterans Affairs, 27 N.E.3d 271, 273 (Ind. 

2015) (internal citations and quotations omitted).

[20] The Hospital was required to prove by clear and convincing evidence that A.M.

is mentally ill and either dangerous or gravely disabled and that detention or 

commitment of A.M. is appropriate. See Ind. Code § 12-26-2-5(e). When we 

review the sufficiency of the evidence to support a civil commitment, “‘an 

appellate court 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.’” Commitment of M.E. v. Dep’t of 

Veterans Affairs, 64 N.E.3d 855, 861 (Ind. Ct. App. 2016) (quoting T.K., 27 

N.E.3d at 273) (internal quotation omitted)), disapproved of on other grounds by 

A.A. v. Eskenazi Health/Midtown CMHC, 97 N.E.3d 606, 611 (Ind. 2018)). Clear 

and convincing evidence requires proof that the existence of a fact is “highly 

probable.” Id. “‘There is no constitutional basis for confining a mentally ill 

person who is not dangerous and can live safely in freedom.’” Id. (quoting 

Commitment of J.B. v. Midtown Mental Health Ctr., 581 N.E.2d 448, 451 (Ind. Ct. 

App. 1991)).

[21] Indiana Code section 12-7-2-96 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:
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(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.

Because this statute is written in the disjunctive, a trial court’s finding of grave 

disability survives if we find that there was clear and convincing evidence to 

prove either that the individual was unable to provide for his basic needs or that 

her judgment, reasoning, or behavior was so impaired or deteriorated that it 

resulted in her inability to function independently. Commitment of B.J. v. Eskenazi 

Hosp./Midtown CMHC, 67 N.E.3d 1034, 1039 (Ind. Ct. App. 2016).

[22] It is important to recall that denial of mental illness and refusal to medicate, 

standing alone, are legally insufficient to establish grave disability because they 

do not establish by clear and convincing evidence that the individual is unable 

to function independently. See T.K., 27 N.E.3d at 276. Moreover, since 

everyone exhibits some abnormal conduct at one time or another, “loss of 

liberty [through a commitment] calls for a showing that the individual suffers 

from something more serious than is demonstrated by idiosyncratic behavior.” 

Addington v. Texas, 441 U.S. 418, 427 (1979).

[23] A.M. concedes that she is mentally ill but argues that the Hospital failed to 

prove by clear and convincing evidence that she is “in danger of coming to 

harm” as a result of her mental illness. Appellant’s Br. at 10 (citing I.C. § 12-7-
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2-96). Specifically, A.M. claims that her refusal to shower is not clear and 

convincing evidence that she is in danger of coming to harm. A.M. also asserts 

that the hospital failed to prove that she is unable to provide food, clothing and 

shelter for herself. A.M. concedes that she “may not be functioning optimally or 

ideally,” but “‘unusual decisions’ or ‘certain behaviors characteristic of a person 

with [a mental illness]” are not sufficient to uphold an involuntary commitment 

based on grave disability.” Id. at 13 (quoting In the Matter of the Commitment of 

K.F. v. St. Vincent Hosp. and Health Care Ctr., 909 N.E.2d 1063, 1067 (Ind. Ct. 

App. 2009), disapproved on other grounds by T.K., 27 N.E.3d at 274).

[24] The Hospital argues that Dr. Puri’s testimony is sufficient to meet the clear and 

convincing evidence standard. Dr. Puri testified that as a result of her mental 

illness, A.M. is unable to function independently. Tr. p. 9. A.M. admitted that 

she lacks income and lives a transient lifestyle. A.M. does not properly care for 

her hygiene, and she throws and talks to her food. A.M. denies her mental 

illness and refuses to take her medication. Importantly, although the last two 

factors are, standing alone, insufficient to establish grave disability, they may

still be considered in determining whether A.M. is gravely disabled.

[25] A.M. attempts to analogize her case to other cases reversing temporary 

commitments because there was insufficient evidence to establish that the 

patient was gravely disabled. In T.K., there was no evidence presented to 

dispute the patient’s ability to provide food, clothing and shelter for himself 

because he was employed, owned two vehicles and rented his own home. 27 
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N.E.3d at 276. In M.E., the patient was able to function independently, ate 

properly, lived alone in his rented apartment and was able to clothe himself, 

and the petitioning hospital’s reliance on M.E.’s past behavior could not be 

utilized at the time of the commitment hearing to establish grave disability. 64 

N.E.3d at 862–63. Finally, in K.F., the petitioning hospital presented only the 

doctor’s equivocal testimony concerning whether the patient was able to 

function independently, there was no concern about her ability to care for her 

basic needs, and K.F.’s husband and son testified that she could function 

independently. 909 N.E.2d at 1066–67.

[26] In contrast, A.M. is admittedly transient and does not have a stable income or 

shelter. And Dr. Puri testified that if A.M. were released from the Hospital, she 

would not be able to function independently. Also, and quite importantly, the 

Hospital was required to forcibly administer two psychotropic medications to 

de-escalate A.M.’s behavior while under her emergency commitment. Under 

these facts and circumstances, we conclude that the Hospital presented clear 

and convincing evidence that as a result of her mental illness, A.M. is gravely 

disabled because she is in danger of coming to harm from her inability to 

function independently.

Conclusion

[27] Under controlling precedent, A.M. waived her claim that the temporary 

involuntary commitment order is defective, because she did not raise the 

argument in the trial court. Further, we affirm the trial court’s commitment 
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order because we conclude that the order is supported by clear and convincing 

evidence of grave disability.

[28] Affirmed.

Bradford, J., and Altice, J., concur.