FILED Jan 08 2025, 8:55 am
CLERK Indiana Supreme Court Court of Appeals and Tax Court
IN THE
Court of Appeals of Indiana Commitment of J.D., Appellant-Respondent,
v.
Richard L. Roudebush Veterans Affairs Medical Center, Appellee-Petitioner.
January 8, 2025
Court of Appeals Case No. 24A-MH-2876
Appeal from the Marion Superior Court
The Honorable David Certo, Judge
Trial Court Cause No. 49D08-2411-MH-52078
Court of Appeals of Indiana | Opinion 24A-MH-2876 | January 8, 2025 Page 1 of 9 Opinion by Senior Judge Robb Judge Mathias and Judge Tavitas concur.
Robb, Senior Judge.
Statement of the Case [1] J.D. appeals the trial court’s order of temporary civil commitment. He claims
the Richard J. Roudebush Veterans Affairs Medical Center (“the Center”)
failed to provide sufficient evidence to support the court’s order. Concluding
that the evidence is sufficient, we affirm.
Facts and Procedural History [2] J.D. arrived at the Center’s emergency department on November 12, 2024. He
was there voluntarily, and he explained he needed medication but was unable
to contact his regular doctor.
[3] J.D. is sixty-eight years old, with a history of mental health hospitalizations,
including a stint at the Center earlier in 2024. In 1977, he was diagnosed with
schizoaffective disorder, bipolar type. J.D.’s current treating psychiatrist
explained J.D.’s illness “suggest[s]” that “he has psychotic symptoms at
baseline when he’s not medicated[.]” Tr. p. 18. J.D. also has a history of
manic episodes.
Court of Appeals of Indiana | Opinion 24A-MH-2876 | January 8, 2025 Page 2 of 9 [4] J.D. was unhoused at the time of his arrival. His elderly mother had previously
been involved in his care, but J.D. described her as “a devil” and subsequently
refused to allow his treatment team to speak with her about his status. Id. at 25.
[5] The Center’s personnel transferred J.D. from the emergency department to
inpatient care under circumstances not explained in the record. After J.D.
began receiving inpatient treatment, he displayed “disorganized kind of
disruptive intrusive behavior[.]” Id. at 17. For example, during one encounter
with his psychiatrist, he made “gestures or threats about stating something to
the tune of stabbing a nurse and kind of doing a gesture like this as if with a
pen.” Id. at 16. On another occasion, J.D. reported that he had struck a Center
employee the previous night.
[6] J.D. displayed other symptoms consistent with his diagnosis of schizoaffective
disorder, including “talking to himself, him talking at a wall, him writing down
on . . . sheets of notebook paper, things that are kind of disorganized and
nonsensical.” Id. at 17. In addition, he showed signs of delusional thinking,
which manifested as “hyper religiosity.” Id. at 19. J.D. told a doctor that other
patients at the Center were not getting better due to medications, but because
J.D.’s presence was healing them.
[7] J.D.’s physicians prescribed two medications for him: an antipsychotic drug
and a mood stabilizer. He had previously taken those medicines on an
outpatient basis. After being admitted to the Center, J.D. often refused to take
his medications or would only accept them at certain times of day. And the
Court of Appeals of Indiana | Opinion 24A-MH-2876 | January 8, 2025 Page 3 of 9 times at which he accepted the medications changed from day to day. J.D.’s
psychiatrist later explained that taking the medications at a consistent time and
dosage over “many days” is important to address J.D.’s symptoms. Id. at 20.
[8] J.D.’s psychiatrist concluded J.D. had a “mixed insight” into his illness and
treatments. Id. at 25. J.D. acknowledged being on medications in the past, but
he did not appear to have “insight as it pertains to taking the medications, to
improve his symptoms, to organize a meaningful discharge.” Id. As a result,
the psychiatrist did not see any improvements in J.D.’s symptoms or in his
approach to acknowledging and managing his illness, explaining that J.D.’s
inconsistency in taking medications prevented him from learning which dosage
levels would be effective.
[9] Based on J.D.’s frequent refusal of medications and other signs of disorganized
behavior, the psychiatrist had concerns about J.D.’s ability to meal plan, shop
for groceries, or obtain transportation on his own. In particular, J.D.’s
challenges in communicating with others while not on medication indicated he
would not function well in an outpatient setting. The psychiatrist was further
concerned that J.D. would likely get into altercations in public.
[10] J.D.’s treatment team did not engage in discharge planning with him because
he failed to show improvement. He told his psychiatrist that, upon release, he
intended to seek medical marijuana from a different Indianapolis hospital and
get a meal at a specific restaurant.
Court of Appeals of Indiana | Opinion 24A-MH-2876 | January 8, 2025 Page 4 of 9 [11] On November 18, 2024, the Center petitioned to have J.D. involuntarily
committed to its care. The Center, by one of J.D.’s physicians, stated J.D.’s
mental illness placed him “in danger of coming to harm because of his inability
to provide for his food, clothing, shelter, or other essential human needs.”
Appellant’s App. Vol. II, p. 13. In particular, the Center asserted J.D. would
not take his medications or participate in a treatment plan.
[12] The trial court scheduled an evidentiary hearing for November 25. On the
night before the hearing, J.D. slept for only four hours. On previous nights, he
had intermittent periods of decreased sleep. J.D.’s psychiatrist thought J.D.’s
inability to sleep was “suggestive of decompensation of his illness.” Tr. p. 23.
[13] The court held the hearing as scheduled, and J.D. testified. He conceded he
was mentally ill. But J.D. also testified he was being stalked by a nurse at the
Center. When asked if he had housing options upon discharge from the Center,
J.D. stated only that another patient had given him a number to call for
housing, but he had lost the number.
[14] The trial court issued an order granting the Center’s petition and committing
J.D. to the Center for no more than ninety days. The court determined J.D.
was gravely disabled and “incapable of housing, feeding, and clothing himself.”
Appellant’s App. Vol. II, p. 11. This appeal followed.
Discussion and Decision [15] J.D. claims the Center failed to present sufficient evidence to demonstrate he is
gravely disabled. When reviewing the sufficiency of the evidence supporting an Court of Appeals of Indiana | Opinion 24A-MH-2876 | January 8, 2025 Page 5 of 9 order of civil commitment, we consider only the probative evidence and
reasonable inferences supporting it, without weighing evidence or assessing
witness credibility. F.L. v. Cmty. Fairbanks Behav. Health, 245 N.E.3d 1033, 1035
(Ind. Ct. App. 2024), trans. denied. We will affirm if clear and convincing
evidence supports the trial court’s order. Id. “Clear and convincing evidence
requires proof that the existence of a fact is ‘highly probable.’” Id. (quoting
Matter of Commitment of C.N., 116 N.E.3d 544, 547 (Ind. Ct. App. 2019)).
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FILED Jan 08 2025, 8:55 am
CLERK Indiana Supreme Court Court of Appeals and Tax Court
IN THE
Court of Appeals of Indiana Commitment of J.D., Appellant-Respondent,
v.
Richard L. Roudebush Veterans Affairs Medical Center, Appellee-Petitioner.
January 8, 2025
Court of Appeals Case No. 24A-MH-2876
Appeal from the Marion Superior Court
The Honorable David Certo, Judge
Trial Court Cause No. 49D08-2411-MH-52078
Court of Appeals of Indiana | Opinion 24A-MH-2876 | January 8, 2025 Page 1 of 9 Opinion by Senior Judge Robb Judge Mathias and Judge Tavitas concur.
Robb, Senior Judge.
Statement of the Case [1] J.D. appeals the trial court’s order of temporary civil commitment. He claims
the Richard J. Roudebush Veterans Affairs Medical Center (“the Center”)
failed to provide sufficient evidence to support the court’s order. Concluding
that the evidence is sufficient, we affirm.
Facts and Procedural History [2] J.D. arrived at the Center’s emergency department on November 12, 2024. He
was there voluntarily, and he explained he needed medication but was unable
to contact his regular doctor.
[3] J.D. is sixty-eight years old, with a history of mental health hospitalizations,
including a stint at the Center earlier in 2024. In 1977, he was diagnosed with
schizoaffective disorder, bipolar type. J.D.’s current treating psychiatrist
explained J.D.’s illness “suggest[s]” that “he has psychotic symptoms at
baseline when he’s not medicated[.]” Tr. p. 18. J.D. also has a history of
manic episodes.
Court of Appeals of Indiana | Opinion 24A-MH-2876 | January 8, 2025 Page 2 of 9 [4] J.D. was unhoused at the time of his arrival. His elderly mother had previously
been involved in his care, but J.D. described her as “a devil” and subsequently
refused to allow his treatment team to speak with her about his status. Id. at 25.
[5] The Center’s personnel transferred J.D. from the emergency department to
inpatient care under circumstances not explained in the record. After J.D.
began receiving inpatient treatment, he displayed “disorganized kind of
disruptive intrusive behavior[.]” Id. at 17. For example, during one encounter
with his psychiatrist, he made “gestures or threats about stating something to
the tune of stabbing a nurse and kind of doing a gesture like this as if with a
pen.” Id. at 16. On another occasion, J.D. reported that he had struck a Center
employee the previous night.
[6] J.D. displayed other symptoms consistent with his diagnosis of schizoaffective
disorder, including “talking to himself, him talking at a wall, him writing down
on . . . sheets of notebook paper, things that are kind of disorganized and
nonsensical.” Id. at 17. In addition, he showed signs of delusional thinking,
which manifested as “hyper religiosity.” Id. at 19. J.D. told a doctor that other
patients at the Center were not getting better due to medications, but because
J.D.’s presence was healing them.
[7] J.D.’s physicians prescribed two medications for him: an antipsychotic drug
and a mood stabilizer. He had previously taken those medicines on an
outpatient basis. After being admitted to the Center, J.D. often refused to take
his medications or would only accept them at certain times of day. And the
Court of Appeals of Indiana | Opinion 24A-MH-2876 | January 8, 2025 Page 3 of 9 times at which he accepted the medications changed from day to day. J.D.’s
psychiatrist later explained that taking the medications at a consistent time and
dosage over “many days” is important to address J.D.’s symptoms. Id. at 20.
[8] J.D.’s psychiatrist concluded J.D. had a “mixed insight” into his illness and
treatments. Id. at 25. J.D. acknowledged being on medications in the past, but
he did not appear to have “insight as it pertains to taking the medications, to
improve his symptoms, to organize a meaningful discharge.” Id. As a result,
the psychiatrist did not see any improvements in J.D.’s symptoms or in his
approach to acknowledging and managing his illness, explaining that J.D.’s
inconsistency in taking medications prevented him from learning which dosage
levels would be effective.
[9] Based on J.D.’s frequent refusal of medications and other signs of disorganized
behavior, the psychiatrist had concerns about J.D.’s ability to meal plan, shop
for groceries, or obtain transportation on his own. In particular, J.D.’s
challenges in communicating with others while not on medication indicated he
would not function well in an outpatient setting. The psychiatrist was further
concerned that J.D. would likely get into altercations in public.
[10] J.D.’s treatment team did not engage in discharge planning with him because
he failed to show improvement. He told his psychiatrist that, upon release, he
intended to seek medical marijuana from a different Indianapolis hospital and
get a meal at a specific restaurant.
Court of Appeals of Indiana | Opinion 24A-MH-2876 | January 8, 2025 Page 4 of 9 [11] On November 18, 2024, the Center petitioned to have J.D. involuntarily
committed to its care. The Center, by one of J.D.’s physicians, stated J.D.’s
mental illness placed him “in danger of coming to harm because of his inability
to provide for his food, clothing, shelter, or other essential human needs.”
Appellant’s App. Vol. II, p. 13. In particular, the Center asserted J.D. would
not take his medications or participate in a treatment plan.
[12] The trial court scheduled an evidentiary hearing for November 25. On the
night before the hearing, J.D. slept for only four hours. On previous nights, he
had intermittent periods of decreased sleep. J.D.’s psychiatrist thought J.D.’s
inability to sleep was “suggestive of decompensation of his illness.” Tr. p. 23.
[13] The court held the hearing as scheduled, and J.D. testified. He conceded he
was mentally ill. But J.D. also testified he was being stalked by a nurse at the
Center. When asked if he had housing options upon discharge from the Center,
J.D. stated only that another patient had given him a number to call for
housing, but he had lost the number.
[14] The trial court issued an order granting the Center’s petition and committing
J.D. to the Center for no more than ninety days. The court determined J.D.
was gravely disabled and “incapable of housing, feeding, and clothing himself.”
Appellant’s App. Vol. II, p. 11. This appeal followed.
Discussion and Decision [15] J.D. claims the Center failed to present sufficient evidence to demonstrate he is
gravely disabled. When reviewing the sufficiency of the evidence supporting an Court of Appeals of Indiana | Opinion 24A-MH-2876 | January 8, 2025 Page 5 of 9 order of civil commitment, we consider only the probative evidence and
reasonable inferences supporting it, without weighing evidence or assessing
witness credibility. F.L. v. Cmty. Fairbanks Behav. Health, 245 N.E.3d 1033, 1035
(Ind. Ct. App. 2024), trans. denied. We will affirm if clear and convincing
evidence supports the trial court’s order. Id. “Clear and convincing evidence
requires proof that the existence of a fact is ‘highly probable.’” Id. (quoting
Matter of Commitment of C.N., 116 N.E.3d 544, 547 (Ind. Ct. App. 2019)).
[16] A petitioner in an involuntary commitment proceeding “is required to prove by
clear and convincing evidence that . . . the individual is mentally ill and either
dangerous or gravely disabled; and . . . detention or commitment of that
individual is appropriate.” Ind. Code § 12-26-2-5(e) (2007). J.D. does not
dispute he is mentally ill. We focus on the question of grave disability.
[17] The General Assembly has defined “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:
(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).
Court of Appeals of Indiana | Opinion 24A-MH-2876 | January 8, 2025 Page 6 of 9 [18] Because Indiana Code section 12-7-2-96 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 was so impaired or
deteriorated that it resulted in his inability to function independently.”
Commitment of B.J. v. Eskenazi Hosp./Midtown CMHC, 67 N.E.3d 1034, 1039
(Ind. Ct. App. 2016). In addition, Section 12-7-2-96 is written in the present
tense and “requires the trier of fact to assess the individual’s state at the time of
the hearing” rather than consider “future contingencies.” Id. at 1040.
[19] In J.D.’s case, he was inconsistent in taking medications. As a result, his
psychiatrist did not see any improvement in J.D’s symptoms and could not
determine the correct dosages for J.D.’s medications. In addition, J.D. engaged
in aggressive behavior while in the Center, punching one employee and
threatening to stab another. And J.D.’s poor sleep suggested his symptoms
were worsening rather than improving.
[20] J.D. had only a “mixed insight” into his mental health diagnosis, as his
psychiatrist explained: “I don’t have reason to believe that he has insight as it
pertains to taking the medications, to improve his symptoms, to organize a
meaningful discharge.” Tr. p. 25. Indeed, J.D. implied he knew better than the
treatment team what his medication dosages should be, testifying: “I know
how this works. I know my body.” Tr. p. 33.
Court of Appeals of Indiana | Opinion 24A-MH-2876 | January 8, 2025 Page 7 of 9 [21] J.D. was unhoused when he arrived at the Center, and as of the time of the
hearing, he had no plans for housing upon discharge. Instead, he said only that
he intended to obtain marijuana and dine at a specific restaurant. J.D.’s
psychiatrist concluded that J.D. could not successfully obtain shelter or
organize a shopping trip without further inpatient treatment. In addition, J.D.
was at risk of getting into altercations in public, based on his aggressive
behavior.
[22] J.D. argues that he maintained appropriate hygiene and ate regularly while at
the Center. He also claims he could obtain food and shelter from entities that
provide services to the unhoused. These arguments amount to requests to
reweigh the evidence, which our standard of review forbids.
[23] J.D. also notes he arrived at the Center voluntarily to seek medication, which
he claims demonstrates he takes responsibility for his medical needs. But the
record is silent as to whether, prior to presenting himself at the emergency
room, J.D. displayed the same delusional thinking and disordered behavior that
he displayed shortly after he was admitted to the Center as a patient. Further,
J.D.’s arrival at the Center of his own free will, with some recognition that he
needs treatment, is not inconsistent with his psychiatrist’s explanation that J.D.
is unwilling to take medications as directed. And J.D.’s refusal to stick to a
treatment plan resulted in the medicine being inadequate to treat his serious
symptoms. We conclude the Center provided sufficient evidence to establish,
under the clear and convincing evidence standard, that J.D. cannot provide for
his essential human needs on his own due to his mental illness. See F.L., 245
Court of Appeals of Indiana | Opinion 24A-MH-2876 | January 8, 2025 Page 8 of 9 N.E.3d at 1034, 1036 (evidence sufficient to support determination patient was
gravely disabled; patient initially sought help by calling 911 but subsequently
refused to take medicine and displayed deterioration in judgment rendering her 1 unable to meet her essential needs).
Conclusion [24] For the reasons stated above, we affirm the judgment of the trial court.
[25] Affirmed.
Mathias, J., and Tavitas, J., concur.
ATTORNEY FOR APPELLANT Talisha R. Griffin Marion County Public Defender Agency Indianapolis, Indiana
ATTORNEY FOR APPELLEE Rachel B. Gallagher Special Assistant United States Attorney Veterans Administration Indianapolis, Indiana
1 Because there is sufficient evidence to sustain the trial court’s judgment on grounds of grave disability, we need not address the second element of Indiana Code section 12-7-2-96, which addresses a patient’s inability to function independently due to a substantial impairment or an obvious deterioration of the patient’s judgment.
Court of Appeals of Indiana | Opinion 24A-MH-2876 | January 8, 2025 Page 9 of 9