Commitment of A B

• Court: Indiana Court of Appeals
• Decided: July 19, 2024
• Docket: 23A-MH-03052
• Status: Published

Opinion

FILED Jul 19 2024, 8:56 am

CLERK Indiana Supreme Court Court of Appeals and Tax Court

IN THE

Court of Appeals of Indiana In the Matter of the Civil Commitment of A.B., Appellant-Respondent,

v.

St. Vincent Hospital and Health Care Center, Inc. d/b/a St. Vincent Stress Center, Appellee-Petitioner.

July 19, 2024

Court of Appeals Case No. 23A-MH-3052

Appeal from the Marion Superior Court

The Honorable David Certo, Judge

Court of Appeals of Indiana | Opinion 23A-MH-3052 | July 19, 2024 Page 1 of 13 Trial Court Cause No. 49D08-2311-MH-43365

Opinion by Senior Judge Robb Judges Riley and Pyle concur.

Robb, Senior Judge.

Statement of the Case [1] A.B. was the subject of a temporary involuntary civil commitment. Although

the commitment order has expired, A.B. appeals challenging the validity of the

order. Finding the appeal not moot and the evidence insufficient, we reverse

and remand with instructions.

Issues [2] A.B. raises two issues for our review, the first of which is a threshold issue:

I. Whether this appeal is not moot, despite the expiration of the commitment order.

II. Whether sufficient evidence was presented to support the trial court’s order involuntarily committing A.B. to a mental health facility.

Facts and Procedural History [3] A.B. is a twenty-year-old woman who has been diagnosed with unspecified

psychotic disorder and cannabis use disorder. She was hospitalized as a result

of her mental illness in August and September 2023 prior to this commitment in

Court of Appeals of Indiana | Opinion 23A-MH-3052 | July 19, 2024 Page 2 of 13 November. When she was discharged from her August hospitalization, she did

not maintain her prescribed oral medication.

[4] In November, A.B. contacted her parents to pick her up from the Marion

County Justice Center. On the way home, A.B. was mumbling under her

breath and opened the car door while the car was traveling on the interstate.

Although A.B. insisted she was simply throwing something out of the car, her

parents decided to take her to the Stress Center. At a stoplight on the way to

the hospital, A.B. exited the car and told her parents she was going to check

into the Stress Center on her own. She refused to get back into her parents’ car,

but eventually agreed to being taken to the Stress Center by a hospital security

officer.

[5] Dr. Erica Cornett, a psychiatrist at the Stress Center, evaluated A.B. and found

her to be “acutely psychotic,” “paranoid,” and “suspicious” with a “bizarre and

illogical” thought process. Appellant’s App. Vol. II, p. 20. Dr. Cornett applied

for an emergency detention, which the trial court granted, and a hearing for

temporary commitment was scheduled.

[6] At the commitment hearing, Dr. Cornett testified to A.B.’s previous Stress

Center admission in August when she was also “very paranoid” and “very

suspicious.” Tr. Vol. II, p. 7. During that admission, A.B. took the prescribed

medication, and Dr. Cornett believed A.B. was “a bit better,” “not as

suspicious,” and “not as paranoid” when she was released. Id. at 8.

Court of Appeals of Indiana | Opinion 23A-MH-3052 | July 19, 2024 Page 3 of 13 [7] Dr. Cornett then testified concerning A.B.’s current admission. She explained

that A.B. was exhibiting unusual behaviors such as using hand gestures to

communicate in a fashion similar to sign language; wearing a wrap on her head

“to protect her privacy”; walking and turning as if she was “in marching band”;

standing on her bed; and claiming she has a parasite in her body. Id. at 8. In

addition, Dr. Cornett stated that A.B. was refusing medication because she did

not believe she needed it and because she claimed the parasite would take the

medication, not her. Dr. Cornett testified that A.B. exhibits no insight into her

condition.

[8] Dr. Cornett acknowledged that A.B. was neither malnourished nor dehydrated

when she was admitted to the Stress Center. She further testified that during

the emergency detention, A.B. “takes care of her ADLs,” meaning “activities of

daily living,” and specified that A.B. ate and showered. Id. at 9.

[9] A.B.’s mother testified that A.B.’s behavior the last few months has been “very

erratic” and uncharacteristic. Id. at 22. After the admission to the Stress Center

in August, A.B. was with her family on an out-of-town trip in September.

During the trip, A.B. behaved erratically, was highly agitated, and admitted

that she was “seeing and speaking with spirits.” Id. at 24. Upon returning

home, A.B. was admitted to Fairbanks Hospital for approximately a week.

When she was released from Fairbanks, A.B. stayed with her parents for a

couple of weeks before returning to her apartment.

Court of Appeals of Indiana | Opinion 23A-MH-3052 | July 19, 2024 Page 4 of 13 [10] A.B.’s mother further testified that A.B. had reported applying for several jobs

and had indicated she would be signing a singing contract, but nothing had

“fallen into place.” Id. at 26. She also testified that within the past six months

A.B. had worked for a couple of weeks at a care group for autistic young adults.

[11] Lastly, A.B. testified. She explained that a particular event triggered her

feelings of stress and fear that led to her August Stress Center admission but

that she felt better when she was released. In contrast, she stated she felt “fine”

and “completely coherent” at the time of her current admission. On the day of

the hearing, she did not feel paranoid but rather she felt “[o]ptimistic” and

“normal.” Id. at 33.

[12] A.B. further testified that she had been tested for parasites and that she had a

medical appointment scheduled in that regard. She testified the offer for a

singing contract had been rescinded, but she was currently employed at a

therapy center. She also testified that she is a registered behavior technician

(RBT). While A.B. indicated she might be willing to try injectable medication,

she definitely would be willing to take the oral medication she was given in

August. On cross examination, A.B. disclosed that when her parents picked

her up from the justice center, she had been arrested for trespassing in an

incident involving a former co-worker.

[13] The trial court found that A.B. was gravely disabled and granted the Stress

Center’s request to temporarily commit A.B. for up to ninety days. A.B. now

appeals.

Court of Appeals of Indiana | Opinion 23A-MH-3052 | July 19, 2024 Page 5 of 13 Discussion and Decision I. Mootness [14] Although A.B. timely appealed, her temporary commitment order has expired.

Accordingly, the threshold issue is whether this appeal is moot. She argues we

should reach the merits of her claim due to the possible enduring effects of her

commitment. For its part, the Stress Center takes no position on this issue.

[15] The long-standing rule in Indiana courts is that a case is deemed moot and

should be dismissed when the controversy has been disposed of in some manner

such that the court can give the parties no effective relief and thus it is

unnecessary to decide the question at issue. T.W. v. St. Vincent Hosp. & Health

Care Ctr., Inc., 121 N.E.3d 1039, 1042 (Ind. 2019). Recently, however, this

Court considered the merits of an appeal from an expired temporary

commitment order based on the collateral consequences doctrine. See Civ.

Commitment of C.P. v. St. Vincent Hosp. & Health Care Ctr., Inc., 219 N.E.3d 142

(Ind. Ct. App. 2023). There, we applied the doctrine to hold that appeals from

expired involuntary civil commitment orders are not moot but are properly

before us on their merits based on the negative collateral consequences that

accompany the orders. See id. at 148-49 (appellant demonstrated that, as

collateral consequence of order, he would be prohibited from continuing his

long-exercised right of possessing handgun). We subsequently clarified that

“we should apply this doctrine only when the appellant demonstrates a

particularized collateral consequence flowing from the temporary commitment

Court of Appeals of Indiana | Opinion 23A-MH-3052 | July 19, 2024 Page 6 of 13 order.” J.F. v. St. Vincent Hosp. & Health Care Ctr., Inc., 222 N.E.3d 1020, 1024

(Ind. Ct. App. 2023) (emphasis added).

[16] Here, A.B. is concerned that this involuntary commitment will have a negative

impact on her ability to maintain her RBT certification and will serve as the

basis for future involuntary treatment. According to A.B., to maintain her

certification she must report any mental health hospitalizations that impact her

ability to provide services as a RBT. See Appellant’s Br. pp. 12-13. Given these

circumstances, A.B. has sufficiently shown a particularized harmful

consequence is likely to result if we decline to reach the merits of her appeal.

Therefore, we consider the merits of A.B.’s appeal based on the collateral

consequences doctrine.

[17] Because we hold that A.B.’s potential loss of certification is sufficient to enable

appellate review of her commitment, we need not consider her additional

proffered collateral consequence that a valid commitment order would make

future involuntary commitment proceedings against her more likely to succeed.

We nevertheless note this Court has previously held this is not a sufficiently

particularized harmful consequence to cause us to reach the merits of an appeal.

See J.F., 222 N.E.3d at 1024. We now turn to the merits of A.B.’s appeal.

II. Sufficiency of Evidence [18] A.B. contends the evidence was not sufficient to support the court’s order of

involuntary commitment. Civil commitment proceedings serve two purposes:

(1) to protect the public and (2) to protect the rights of the person for whom

Court of Appeals of Indiana | Opinion 23A-MH-3052 | July 19, 2024 Page 7 of 13 commitment is sought. A.S. v. Indiana Univ. Health Bloomington Hosp., 148

N.E.3d 1135, 1138 (Ind. Ct. App. 2020). Because the liberty interest at stake in

civil commitment proceedings encompasses more than a loss of one’s physical

freedom, such proceedings are subject to the requirements of the Due Process

Clause. Id. (quoting Civil Commitment of T.K. v. Dep’t of Veterans Affs., 27 N.E.3d

271, 273 (Ind. 2015)).

[19] To comport with due process requirements, a commitment order must be

supported by clear and convincing evidence. A.S., 148 N.E.3d at 1139. On

review of a determination made under such a standard, we will consider only

the probative evidence as well as any reasonable inferences flowing therefrom,

and we will not reweigh the evidence or reassess witness credibility. Id. As our

courts have repeatedly stated, “‘[t]here 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) (quoting

Commitment of M.M. v. Clarian Health Partners, 826 N.E.2d 90, 97 (Ind. Ct. App.

2005), trans. denied), trans. denied.

[20] The Stress Center was required to prove by clear and convincing evidence that

A.B. is (1) mentally ill, (2) either dangerous or gravely disabled, and (3) that her

commitment is appropriate. See Ind. Code § 12-26-2-5(e) (2007). A.B. does not

dispute the trial court’s finding that she is mentally ill. However, she argues

there was not sufficient evidence to support the trial court’s conclusion that she

is gravely disabled.

Court of Appeals of Indiana | Opinion 23A-MH-3052 | July 19, 2024 Page 8 of 13 [21] “Gravely disabled” 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 (1992). Because this statute is written in the disjunctive,

a court’s finding of grave disability survives if there was sufficient evidence to

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

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

could not function independently.

[22] Here, the court found A.B. gravely disabled under Section 12-7-2-96(2), stating

that “her judgment and reasoning is [sic] grossly impaired” because she was

recently arrested, had been hospitalized twice in the previous six months for

mental health concerns, believes she has a parasite that impairs her ability to

metabolize her medications, has not had gas service in her apartment since

July, exhibited bizarre behavior in the hospital, and, “in the face of all those

things,” states she feels fine. Tr. Vol. II, p. 52. In its written order, the court

listed only A.B.’s belief that she was infested with a parasite, her opening of a

car door on the highway, and her inability to restore her gas service.

Appellant’s App. Vol. II, p. 17.

Court of Appeals of Indiana | Opinion 23A-MH-3052 | July 19, 2024 Page 9 of 13 [23] Although the court made its decision based on its belief that A.B.’s judgment

was impaired under Section 12-7-2-96(2), the evidence included factors that

pertain to the ability to care for oneself under Section 12-7-2-96(1). Because the

court highlighted some of these factors in issuing its findings at the hearing and

in its written order, we briefly address them here to provide a more complete

picture of A.B.’s situation as shown by the evidence.

[24] By all accounts, A.B. lives in an apartment by herself. A.B. has her RBT

certification and, although her mother was not aware of any current

employment, A.B. testified she had returned to a previous job and was currently

employed. A.B. confirmed that the gas service to her apartment had been

discontinued because she was unable to pay the accrued arrearage in full;

however, the unrefuted evidence is that the suspension of service was prior to

A.B.’s mental health hospitalizations and was due to a misunderstanding on her

part. A.B. testified that she was “unaware of the separation of the gas and

electric bill so um upon receiving the notice that my gas was turned off um the

bill had um, built up to a level that I was not able to pay in full.” Tr. Vol. II, p.

42. A.B. further testified that she has access to food, usually through a church

or food bank, and Dr. Cornett confirmed that when A.B. was admitted to the

Stress Center, she was neither malnourished nor dehydrated. Dr. Cornett also

acknowledged that A.B. saw to her activities of daily living by showering and

eating.

[25] We turn now to the finding that A.B.’s judgment was impaired under Section

12-7-2-96(2). The court’s determination was based in part on Dr. Cornett’s

Court of Appeals of Indiana | Opinion 23A-MH-3052 | July 19, 2024 Page 10 of 13 description of A.B.’s strange behavior at the Stress Center, A.B.’s belief she had

been infected with a parasite, her recent arrest for trespass, and her mother’s

account of her opening the car door. Yet, our courts have echoed the caution

called for by the United States Supreme Court in Addington v. Texas, 441 U.S.

418 (1979). As we have noted, the Addington Court expressed concern that a

decision ordering an involuntary commitment might be made on the basis of a

few isolated instances of unusual conduct that occurred within a range of

generally acceptable conduct. T.D. v. Eskenazi Health Midtown Cmty. Mental

Health Ctr., 40 N.E.3d 507, 511 (Ind. Ct. App. 2015) (quoting In re Commitment

of G.M., 743 N.E.2d 1148, 1151 (Ind. Ct. App. 2001)). The Addington Court

opined that because everyone exhibits some abnormal conduct at one time or

another, the loss of liberty that results from an involuntary commitment

necessitates “‘a showing that the individual suffers from something more

serious than is demonstrated by idiosyncratic behavior.’” Id. A.B. insisted in

the car door incident she was simply discarding something from the car.

Nevertheless, it appears to be an isolated incident like the arrest, about which

we have very limited information. And, while A.B.’s other behaviors and

beliefs were unusual, there was no evidence that they prevented her from

functioning independently. The Stress Center’s burden of proof required more

than a showing that A.B. behaved abnormally or idiosyncratically.

[26] Another circumstance that shaped the court’s decision was A.B.’s failure to

recognize her mental illness. However, our Supreme Court explicitly stated in

Civil Commitment of T.K. that “denial of illness and refusal to medicate, standing

Court of Appeals of Indiana | Opinion 23A-MH-3052 | July 19, 2024 Page 11 of 13 alone, are insufficient to establish grave disability because they do not establish,

by clear and convincing evidence, that such behavior ‘results in the individual’s

inability to function independently.’” 27 N.E.3d at 276 (quoting Ind. Code §

12-7-2-96(2)).

[27] Moreover, in a commitment proceeding, the burden on the petitioner under

Section 12-7-2-96(2) is not to simply show impaired judgment that affects the

ability to function independently. Rather, the statute mandates a showing that

the individual is in danger of coming to harm as a result of the impaired judgment

affecting her independent functioning. See Ind. Code § 12-7-2-96; see also T.D.,

40 N.E.3d at 512 (underscoring that definition of “gravely disabled” requires

that individual “is in danger of coming to harm” as result of impaired

judgment). A.B.’s behavior clearly evidences her mental illness and paranoia,

but Section 12-7-2-96 requires more than paranoid beliefs and bizarre behavior

to establish grave disability. The Stress Center was required to establish by

clear and convincing evidence that, with her impaired judgment and behavior,

A.B. could not function independently without coming to harm. The Stress

Center failed in this regard; thus, we must conclude that A.B.’s civil 1 commitment was improper.

1 Given that we conclude there was insufficient evidence to establish that A.B. was gravely disabled, we need not address her argument of the lack of clear and convincing evidence that her commitment was appropriate.

Court of Appeals of Indiana | Opinion 23A-MH-3052 | July 19, 2024 Page 12 of 13 Conclusion [28] We therefore conclude that, based on the collateral consequences doctrine,

A.B.’s appeal is not moot. In addressing the merits of the case, we conclude the

Stress Center’s evidence was not sufficient to support the temporary involuntary

commitment of A.B. based on grave disability, and we reverse the trial court’s

decision and remand for the court to vacate the commitment.

[29] Reversed and remanded with instructions.

Riley, J., and Pyle, J., concur.

ATTORNEYS FOR APPELLANT Talisha R. Griffin, Appellate Division Chief Casey A. Farrington Marion County Public Defender Agency Indianapolis, Indiana

ATTORNEYS FOR APPELLEE Andrew B. Howk Matthew M. Schappa Ryan A. McDonald Hall Render Killian Heath & Lyman, P.C. Indianapolis, Indiana

Court of Appeals of Indiana | Opinion 23A-MH-3052 | July 19, 2024 Page 13 of 13