Court Opinion

ID: 9897326
Source: CourtListenerOpinion
Date Created: 2023-11-14 19:10:11.553293+00
Date Added: 2024-06-11T09:15:43.700116
License: Public Domain

FILED
                                                                      Aug 01 2023, 8:50 am

                                                                           CLERK
                                                                       Indiana Supreme Court
                                                                          Court of Appeals
                                                                            and Tax Court

ATTORNEY FOR APPELLANT                                    ATTORNEYS FOR APPELLEE
Valerie K. Boots                                          Jenny B. Buchheit
Marion County Public Defender Agency                      Sean T. Dewey
Indianapolis, Indiana                                     Alexandria H. Pittman
                                                          Ice Miller LLP
                                                          Indianapolis, Indiana

                                            IN THE
    COURT OF APPEALS OF INDIANA

In the matter of the Civil                                August 1, 2023
Commitment of:                                            Court of Appeals Case No.
                                                          23A-MH-114
K.K.,
                                                          Appeal from the
Appellant-Respondent,                                     Marion Superior Court
        v.                                                The Honorable
                                                          Steven Eichholtz, Judge
Community Health Network,                                 The Honorable
Inc.,                                                     Melanie Kendrick, Magistrate

Appellee-Petitioner                                       Trial Court Cause No.
                                                          49D08-2212-MH-43185

                                  Opinion by Judge Vaidik
                               Judges Mathias and Pyle concur.

Court of Appeals of Indiana | Opinion 23A-MH-114 | August 1, 2023                              Page 1 of 9
      Vaidik, Judge.

      Case Summary
[1]   K.K. appeals the trial court’s order involuntarily committing her to Community

      Health Network, Inc. (“the Hospital”). In addition to challenging the

      sufficiency of the evidence, K.K. argues the court erred in allowing her doctor

      to testify as an expert under Indiana Evidence Rule 702. Her doctor, although

      still a resident, had graduated medical school and had been treating patients for

      several months. The trial court determined this was sufficient knowledge and

      experience to qualify as an expert, and we cannot say this was an error. And

      because we find there is sufficient evidence to support the involuntary

      commitment, we affirm.

      Facts and Procedural History
[2]   In the early morning hours of December 13, 2022, residents of a home in

      Marion County called police and reported K.K., whom they did not know, had

      been standing on their front porch for hours, clothed only in pajamas. Police

      believed K.K. was displaying “erratic behavior” and took her to the Hospital,

      where she was admitted. Tr. Vol. II p. 11.

[3]   Over the next few days, Dr. Beatrice Thunga, a psychiatry resident at the

      Hospital, examined K.K. and found her to have a “disorganized thought

      process” and “disorganized behavior.” Id. at 12. Specifically, K.K. was “barely

      talking” and, when she did talk, was “incoherent.” Id. at 13. When asked
      Court of Appeals of Indiana | Opinion 23A-MH-114 | August 1, 2023         Page 2 of 9
      questions, she would not reply and instead produced items, such as a crayon or

      a piece of paper, but could not explain their significance. Furthermore, she was

      “unable to express emotions” and did not understand that she had a mental

      illness or needed to take medication. Id. Based on her behavior and prior

      medical history, including an involuntary commitment earlier that year, doctors

      at the Hospital diagnosed K.K. with schizoaffective disorder, bipolar type. On

      December 15, a report was filed with the court requesting temporary

      involuntary commitment (up to ninety days).

[4]   An evidentiary hearing was held on December 20. Dr. Thunga testified that she

      had recently graduated medical school in May 2022, held a temporary medical

      license, and was six months into her residency at the Hospital. For four of those

      months, she had been working in psychiatry, which she identified as the

      “particular focus of [her] training.” Id. at 7-8. She primarily worked with adult

      patients “with various mental disorders of mood, substance use and psychosis.”

      Id. at 8. Over K.K.’s objection, the trial court found Dr. Thunga met the

      qualifications as an expert in psychiatry.

[5]   Dr. Thunga testified she had examined K.K. nine times since her admission

      and confirmed that K.K. had been diagnosed with schizoaffective disorder,

      bipolar type. Dr. Thunga stated K.K. suffered from “poverty of speech,”

      meaning that K.K. was “barely talking” and often “incoherent” when she did

      speak. Id. at 13. Dr. Thunga expressed that K.K. showed “declining cognition”

      and was unable to coherently answer questions about her medical care,

      housing, or basic needs. Id. Dr. Thunga also noted that it appeared K.K. was

      Court of Appeals of Indiana | Opinion 23A-MH-114 | August 1, 2023         Page 3 of 9
      not showering, had been wearing the same clothes for almost a week, and was

      not eating. A friend of K.K.’s testified at the hearing and stated he could give

      her a temporary place to stay should she be released but could not offer any

      permanent housing and was unwilling to be responsible for her taking

      prescribed medication or attending medical appointments.

[6]   After the hearing, the trial court entered an order of temporary commitment not

      to exceed ninety days.

[7]   K.K. now appeals.1

      Discussion and Decision
      I. Expert Testimony
[8]   K.K. first argues the trial court erred in allowing Dr. Thunga to testify as an

      expert witness under Indiana Evidence Rule 702, which provides,

              (a) A witness who is qualified as an expert by knowledge, skill,
              experience, training, or education may testify in the form of an
              opinion or otherwise if the expert’s scientific, technical, or other
              specialized knowledge will help the trier of fact to understand the
              evidence or to determine a fact in issue.

      1
       As K.K. acknowledges, her commitment expired on March 20, 2023. But the Hospital does not argue the
      appeal should be dismissed as moot. Therefore, we will address the issues raised by K.K.

      Court of Appeals of Indiana | Opinion 23A-MH-114 | August 1, 2023                           Page 4 of 9
               (b) Expert scientific testimony is admissible only if the court is
               satisfied that the expert testimony rests upon reliable scientific
               principles.

       “Two requirements must be met for a witness to qualify as an expert.” Totton v.

       Bukofchan, 80 N.E.3d 891, 894 (Ind. Ct. App. 2017). “First, the subject matter

       must be distinctly related to some scientific field, business, or profession beyond

       the knowledge of the average layperson; and second, the witness must be

       shown to have sufficient skill, knowledge, or experience in that area so that the

       opinion will aid the trier of fact.” Id.

[9]    The trial court is considered the gatekeeper for the admissibility of expert

       opinion evidence under Rule 702. McDaniel v. Robertson, 83 N.E.3d 765, 773

       (Ind. Ct. App. 2017). A trial court’s determination regarding the admissibility of

       expert testimony under Rule 702 is a matter within its broad discretion and will

       be reversed only for abuse of that discretion. Id. at 772. We presume that the

       trial court’s decision is correct, and the burden is on the party challenging the

       decision to persuade us that the trial court has abused its discretion. Id. at 773.

[10]   K.K. argues the Hospital did not show Dr. Thunga had sufficient experience to

       qualify as an expert. Dr. Thunga completed four years of medical school and

       held a temporary medical license. She had been through six months of

       residency, four of which focused on psychiatry. She identified psychiatry as the

       focus of her training and had experience treating adults with “various mental

       disorders of mood, substance use and psychosis.” And she was K.K.’s treating

       physician, examining her nine times while she was there. Given this evidence,

       Court of Appeals of Indiana | Opinion 23A-MH-114 | August 1, 2023            Page 5 of 9
       and the deference given to trial courts in these circumstances, we cannot say the

       court erred in determining Dr. Thunga met the qualifications for an expert

       witness.

       II. Sufficiency of the Evidence
[11]   K.K. also argues that even with Dr. Thunga’s testimony, the evidence is

       insufficient to support her involuntary commitment. Civil-commitment

       proceedings have two purposes—to protect both the public and the rights of the

       person for whom involuntary commitment is sought. A.S. v. Ind. Univ. Health

       Bloomington Hosp., 148 N.E.3d 1135, 1138 (Ind. Ct. App. 2020). The liberty

       interest at stake in a civil-commitment proceeding goes beyond a loss of one’s

       physical freedom because commitment is accompanied by serious stigma and

       adverse social consequences. Id. Accordingly, proceedings for civil commitment

       are subject to the requirements of the Due Process Clause. Id.

[12]   To satisfy due process, a person may not be committed without clear and

       convincing evidence in support. Id. at 1139. The clear-and-convincing-evidence

       standard is “an intermediate standard of proof greater than a preponderance of

       the evidence and less than proof beyond a reasonable doubt.” B.J. v. Eskenazi

       Hosp./Midtown CMHC, 67 N.E.3d 1034, 1038 (Ind. Ct. App. 2016). Under this

       standard, “we 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

       Court of Appeals of Indiana | Opinion 23A-MH-114 | August 1, 2023          Page 6 of 9
       proven by clear and convincing evidence.” A.S., 148 N.E.3d at 1139 (quotation

       omitted).

[13]   To obtain an involuntary commitment, the petitioner is required to prove by

       clear and convincing evidence that (1) the person is mentally ill and either

       dangerous or gravely disabled and (2) detention or commitment of the person is

       appropriate. Ind. Code § 12-26-2-5(e).

       A. Mentally Ill
[14]   First, K.K. argues the Hospital did not prove by clear and convincing evidence

       that she was mentally ill. A mental illness is defined as a psychiatric disorder

       that substantially disturbs an individual’s thinking, feeling, or behavior and

       impairs the individual’s ability to function. I.C. § 12-7-2-130.

[15]   Dr. Thunga diagnosed K.K. with schizoaffective disorder, bipolar type.

       Specifically with K.K., Dr. Thunga testified that this manifests in “poverty of

       speech,” noting K.K. barely talked, and when she did, she was incoherent.

       Furthermore, Dr. Thunga testified that K.K. was experiencing declining

       cognition and could not answer questions, express emotion, or understand her

       medical needs. This is sufficient evidence from which the trial court could have

       determined K.K. was mentally ill. See G.Q. v. Branam, 917 N.E.2d 703, 707

       (Ind. Ct. App. 2009) (diagnosis of psychiatric disorder and reports of delusional

       thoughts sufficient to show mental illness). K.K. offers alternative explanations

       for this behavior, such as she was protesting her admission to the Hospital, but

       this is a request to reweigh evidence, which we do not do.

       Court of Appeals of Indiana | Opinion 23A-MH-114 | August 1, 2023          Page 7 of 9
       B. Gravely Disabled
[16]   Finally, K.K. argues the Hospital did not prove by clear and convincing

       evidence that she was gravely disabled. We first note that, while Section 12-26-

       2-5(e)(1) is disjunctive (“either dangerous or gravely disabled”), the Hospital did

       not argue at the hearing, nor does it now contend, that K.K. was dangerous.

       Instead, it argues only that she was gravely disabled. “Gravely disabled” is

       defined as a condition that causes an individual to (1) be unable to meet their

       basic food, clothing, and shelter needs or (2) be so obviously impaired in

       judgment, reasoning, or behavior that such individual cannot function

       independently. I.C. § 12-7-2-96.

[17]   Dr. Thunga’s testimony establishes that K.K. was unable to meet her needs. Dr.

       Thunga testified that in the five days K.K. was hospitalized, she did not appear

       to be eating, never changed clothes or showered, and would not take prescribed

       medication. Furthermore, K.K. was experiencing poverty of speech and

       cognitive decline. At no point in the nine examinations over five days was K.K.

       able to coherently communicate with Dr. Thunga about her medical needs or

       housing situation. And while K.K. had a friend who was willing to house her

       temporarily, he could not commit to housing her long term and was unwilling

       to take responsibility for any of her medications. Ultimately, K.K.’s inability to

       communicate, combined with her hygiene, food, and housing issues, supports

       the trial court’s determination that she was gravely disabled. See T.A. v. Wishard

       Health Servs., Midtown Cmty. Mental Health Ctr., 950 N.E.2d 1266, 1271 (Ind. Ct.

       Court of Appeals of Indiana | Opinion 23A-MH-114 | August 1, 2023         Page 8 of 9
       App. 2011) (patient’s inability to explain to doctors how to meet her basic

       needs, including housing, showed she was gravely disabled).

[18]   Affirmed.

       Mathias, J., and Pyle, J., concur.

       Court of Appeals of Indiana | Opinion 23A-MH-114 | August 1, 2023        Page 9 of 9