Commitment of L F

• Court: Indiana Court of Appeals
• Decided: April 10, 2026
• Docket: 26A-MH-00658
• Status: Published
• Author: Judge Weissmann

Opinion

IN THE

Court of Appeals of Indiana FILED In the Matter of the Civil Commitment of: Apr 10 2026, 9:26 am

L.F., CLERK Indiana Supreme Court Court of Appeals Appellant-Respondent and Tax Court

v.

Sandra Eskenazi Mental Health Center, Appellee-Petitioner

April 10, 2026 Court of Appeals Case No. 26A-MH-658 Appeal from the Marion Superior Court The Honorable David J. Certo, Judge Trial Court Cause No. 49D08-2602-MH-10733

Opinion by Judge Weissmann Judges Brown and Foley concur.

Court of Appeals of Indiana | Opinion 26A-MH-658 | April 10, 2026 Page 1 of 11 Weissmann, Judge.

[1] After she was found standing in traffic, police brought L.F. to Eskenazi Mental

Health Center (Eskenazi). At Eskenazi, L.F. told doctors that the leaders of a

foreign nation had schemed to have her placed in the facility. During her

hospitalization, L.F. assaulted another patient she believed was trying to

sexually assault her and refused to take her medication as prescribed. At a

hearing on Eskenazi’s petition to commit her, L.F. admitted she had

schizophrenia but asserted that she had it under control. The trial court

committed L.F. to Eskenazi for up to 90 days. On appeal, L.F. claims her

commitment is not appropriate because its treatment plan requires her to take 1 medication over her objection. We affirm.

Facts [2] L.F. has suffered from schizophrenia for several years. She was taken to

Eskenazi on February 26, 2026, after police found her in the middle of a busy

road calling out for help. Eskenazi applied for, and was granted, emergency

detention of L.F. that day. At Eskenazi, L.F. was treated by Dr. Jason Gallo, a

psychiatry resident in his second month at the hospital. Dr. Gallo reviewed

L.F.’s medical history, including records of her past commitments, and met

1 This expedited appeal is part of the two-year Marion County Expedited Mental Health Appeals Pilot Project established by the Indiana Supreme Court in response to the issue that the standard appellate timeline typically exceeds the duration of a temporary mental health commitment. In re Marion Cnty. Expedited Mental Health Appeals Pilot Project, No. 24S-MS-190, slip op. at 1 (Ind. July 16, 2024).

Court of Appeals of Indiana | Opinion 26A-MH-658 | April 10, 2026 Page 2 of 11 with L.F. seven times. During these meetings, L.F. explained that the

government of Iran had been orchestrating events in her life for ten years,

including a scheme to get her placed in Eskenazi because she fought with the

Ayatollah on social media. L.F. also reported that her signature had been

stolen, sold online, and fraudulently used in her commitment paperwork.

[3] At one point during her stay, L.F. assaulted another patient whom she claimed

was going to rape her, based on the way he was looking at her. Staff intervened,

and L.F. was placed in seclusion for 36 hours. She continued to believe this

patient was going to assault her. Additionally, L.F. twice required acute

medication, which is administered only when a patient is agitated and cannot

be de-escalated verbally or behaviorally.

[4] On March 2, 2026, Eskenazi petitioned to determine whether L.F. should be

temporarily or regularly committed. At a hearing on the petition on March 9,

Dr. Gallo testified about his interactions with L.F. He explained that he had

diagnosed L.F. with schizophrenia. This condition produced active delusions

that impaired L.F.’s judgment and reasoning, according to Dr. Gallo. These

delusions included her concerns about Iran’s involvement in her life, her belief

that her signature was stolen and sold online, and her unverifiable claim that

she was the CEO of a notarizing and arbitration company. Dr. Gallo consulted

with his attending physician, who agreed with his assessment concerning L.F.’s

schizophrenia.

Court of Appeals of Indiana | Opinion 26A-MH-658 | April 10, 2026 Page 3 of 11 [5] Dr. Gallo also testified that L.F. was resistant to taking her prescribed

medication. She first agreed to take medication only on March 6, when Dr.

Gallo recommended 15 milligrams of Abilify. However, L.F. responded that

she would take no more than 8 milligrams for “Dr. Gallo’s safety.” Tr., p. 7.

Dr. Gallo asked what she meant by that, but L.F. “would not elaborate on that

veiled threat.” Id. On the morning of the hearing, L.F. had agreed to take 10

milligrams, but stated that “after the Court hearing she [would] no longer take

Abilify.” Id. at 8.

[6] Dr. Gallo testified that medication compliance is “extremely important” in

managing L.F.’s schizophrenia. Id. He explained that “[s]chizophrenia left

untreated tends to worsen, and symptoms will become exacerbated over time

without treatment.” Id. Taking a lower dosage than recommended could

provide “[s]uboptimal” results, allowing L.F.’s delusions and impairment to

persist. Id. at 23. Dr. Gallo recommended a treatment plan for L.F. of oral

Abilify at regularly-increased dosages until the effective level is determined and

then a transition to a long-acting form of the medication. Dr. Gallo testified that

temporary commitment could stabilize L.F.’s symptoms and treatment could

get her delusions “under control,” allowing her to “live a healthy life.” Id.

[7] L.F. testified that she has schizophrenia but claimed her condition was under

control. She reiterated her concerns about Iran’s involvement with her

hospitalization. L.F. also explained her work on various projects, including a

trademark application and her notarizing and mediation business, and was

concerned that medication made it “hard to think” and “form new memories.”

Court of Appeals of Indiana | Opinion 26A-MH-658 | April 10, 2026 Page 4 of 11 Id. at 35. She stated that if she was discharged that day, she would not take

medication.

[8] The trial court ordered that L.F. be temporarily committed at Eskenazi for a

period not to exceed 90 days, and L.F. appeals.

Discussion and Decision [9] “When reviewing the sufficiency of the evidence supporting a civil

commitment, we consider only the probative evidence and reasonable

inferences supporting it, without weighing evidence or assessing witness

credibility.” A.O. v. Cmty. Health Network, Inc., 206 N.E.3d 1191, 1193 (Ind. Ct.

App. 2023) (citing Civ. Commitment of T.K. v. Dep’t of Veterans Affairs, 27 N.E.3d

271, 273 (Ind. 2015)). “We will affirm if clear and convincing evidence supports

the trial court’s judgment.” 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)).2

[10] To commit L.F., Eskenazi had to prove by clear and convincing evidence that:

(1) L.F. is mentally ill and either dangerous or gravely disabled; and (2) her

detention or commitment is appropriate. See Ind. Code § 12-26-2-5(e). On

2 Many of the cases the parties analyze as comparative authority—G.Q. v. Branam, 917 N.E.2d 703 (Ind. Ct. App. 2009); In re Commitment of G.M., 743 N.E.2d 1148 (Ind. Ct. App. 2001); and In re Commitment of T.K., 993 N.E.2d 245 (Ind. Ct. App. 2013)—were decided under a standard of review that our Supreme Court expressly rejected. See T.K., 27 N.E.3d at 274 (holding that the standard under which an order is affirmed if it “represents a conclusion that a reasonable person could have drawn” incorrectly lowers the burden of proof); A.D. v. Cmty. Fairbanks Behav. Health, 274 N.E.3d 463, 464 (Ind. 2026). We therefore do not rely on those decisions.

Court of Appeals of Indiana | Opinion 26A-MH-658 | April 10, 2026 Page 5 of 11 appeal, L.F. does not challenge the first element. Instead, she claims that her

commitment is “not appropriate” because “[Eskenazi’s] proposed treatment

plan required forcibly medicating L.F., a power granted by the commitment

order.” Appellant’s Br., pp. 4-5. L.F. argues that Eskenazi failed to present

sufficient evidence to override her right to refuse medical treatment. 3

[11] To override a patient’s right to refuse medication, the petitioner must present

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., 510 N.E.2d 645, 647 (Ind. 1987). Additional

limiting principles apply including the requirement that the court determine that

there has been an evaluation of every other form of treatment and that each

alternative has been rejected. Id.

3 L.F. does not dispute the portion of the commitment order requiring her to take all medications as prescribed “upon attaining outpatient status.” Order Temp. Commitment (filed Mar. 9, 2026). She does not raise an argument under the special-conditions framework governing outpatient commitments. See generally Ind. Code § 12-26-14-3; A.S. v. Cmty. Fairbanks Behav. Health, 262 N.E.3d 853, 859 (Ind. Ct. App. 2025).

Court of Appeals of Indiana | Opinion 26A-MH-658 | April 10, 2026 Page 6 of 11 [12] L.F. does not dispute that an individual assessment of her condition was

conducted by Dr. Gallo. Rather, she argues that Eskenazi failed to present

evidence on the other two elements required under M.P.—that the medication

presents substantial benefit and that the benefits outweigh the risks and

concerns—as well as the limiting principle that every other alternative treatment

was considered and rejected. We address each in turn and affirm.

I. Substantial Benefit [13] L.F. claims Dr. Gallo never specifically testified that the Abilify would provide

a “substantial” benefit to treating her schizophrenia, rather than her behavior.

Though he did not use that precise language, Dr. Gallo provided multiple

statements as to the benefits of the recommended medication. He testified that

schizophrenia “left untreated tends to worsen,” and his treatment plan was

designed to get L.F.’s “[d]elusions under control” and allow her to “live a

healthy life.” Tr., pp. 8, 23. He testified that medication compliance was

“[e]xtremely important” for “managing her schizophrenia.” Id. at 8. Dr. Gallo

explained that he selected Abilify after discussing various other options with

L.F. because “Abilify tends to be better” in terms of the sedative side effect that

concerned L.F. Id. at 16.

[14] L.F. claims Dr. Gallo’s statement about treatment stabilizing L.F.’s symptoms

referred to the commitment as a whole and not necessarily the medication.

However, Dr. Gallo made no such distinction between the two in his

testimony, and the only treatment to be administered during the commitment

that was discussed was Abilify. Therefore, the trial court could reasonably infer Court of Appeals of Indiana | Opinion 26A-MH-658 | April 10, 2026 Page 7 of 11 that Dr. Gallo believed the Abilify, rather than the commitment alone, would

stabilize L.F.’s symptoms.

[15] Considering this testimony and the reasonable inferences that could be drawn

from it, the trial court’s determination that the medication provided a

substantial benefit to the treatment of L.F.’s schizophrenia was supported by

clear and convincing evidence. See A.O., 206 N.E.3d at 1193.

II. Benefits Outweigh Risks and Concerns [16] Next, L.F. argues that Dr. Gallo’s testimony on the risk-benefit balance was too

conclusory. She claims that Dr. Gallo “did not discuss a single benefit of

Abilify” or “why the medication was necessary” and, though he listed three

side effects, he acknowledged there were others that he did not name.

Appellant’s Br., p. 6; Reply Br., p. 3. However, the record is not as thin as L.F.

suggests. Under our deferential standard of review, it is enough.

[17] First, Dr. Gallo’s testimony that medication compliance is “extremely

important” for “managing [L.F.’s] schizophrenia” can be understood to mean

that an antipsychotic medication was necessary to effectively treat L.F.’s

condition and reduce her delusions. Tr., p. 8. This inference is further supported

by Dr. Gallo’s concerns that leaving L.F.’s schizophrenia untreated, or treated

with medication below the therapeutic dose, would allow her delusions to

persist—delusions that impaired her judgment and led her to attack a fellow

patient.

Court of Appeals of Indiana | Opinion 26A-MH-658 | April 10, 2026 Page 8 of 11 [18] Dr. Gallo then explained why he had chosen Abilify. He “discussed other[]”

antipsychotic medications with L.F. and selected Abilify because it “tends to be

better” in terms of sedative side effects, which was L.F.’s main concern. Id. at

16. Therefore, Dr. Gallo identified a specific benefit of Abilify.

[19] Finally, Dr. Gallo was aware of Abilify’s side effects, including “restlessness,

vomiting, tremor[s], to name a few.” Id. at 20. Though he did not list every side

effect, his testimony made it clear that he was aware of them and weighed

them. When specifically asked if he believed “the benefits of that suggested

medication will outweigh the potential side effects,” Dr. Gallo responded: “I

do.” Id. at 10.

[20] This individualized balancing reflects a careful selection of Abilify based on

L.F.’s condition, her need for antipsychotic medication, her specific concerns,

and the general side effects. Given Dr. Gallo’s testimony, and the reasonable

inferences that can be drawn from it, clear and convincing evidence supported

the court’s determination that the benefits of treatment with Abilify outweigh

L.F.’s specific concerns about the medication’s side effects and the risks of

leaving L.F.’s condition untreated.

III. Alternative Treatment Options [21] Finally, L.F. argues that Dr. Gallo failed to evaluate every alternative

treatment, as he considered only three options: no medication, Abilify, and

Cobenfy, L.F.’s prior outpatient prescription medication. However, she again

construes the record too narrowly.

Court of Appeals of Indiana | Opinion 26A-MH-658 | April 10, 2026 Page 9 of 11 [22] When asked whether L.F. had agreed to take “any other type of antipsychotic

medication,” Dr. Gallo answered: “No, we discussed others.” Id. at 16. Thus,

Dr. Gallo considered other medications but selected Abilify based on L.F.’s

need for antipsychotic medication and specific concerns about side effects. Dr.

Gallo then explained that he rejected Cobenfy as an option because it caused

nausea in L.F. and she refused to take it. He also rejected the option of no

medication based on L.F.’s history; when her schizophrenia was not treated,

she experienced intense delusions that interfered with her judgment and led to

an assault of a fellow patient.

[23] This evidence supports the conclusion that Dr. Gallo selected Abilify after

considering every alternative treatment and rejecting each. See B.D. v. Ind. Univ.

Health Bloomington Hosp., 121 N.E.3d 1044, 1052 (Ind. Ct. App. 2019) (finding

trial court could have “reasonably concluded” that treating psychiatrist “had

considered, but rejected, all reasonable lesser-restrictive forms of treatment,”

though other non-pharmacological options were not explicitly named).

[24] L.F. attempts to distinguish B.D. because the treating psychiatrist in that case

“testified at the hearing that he had considered lesser-restrictive alternative

treatment options” and Dr. Gallo did not make that specific statement. Id. at

1052. But L.F.’s argument—essentially that the evidence was not specific or

explicit enough—contravenes our standard of review, which permits the trial

court to make reasonable inferences based on the evidence. See A.D. v. Cmty.

Fairbanks Behav. Health, 274 N.E.3d 463, 464 (Ind. 2026).

Court of Appeals of Indiana | Opinion 26A-MH-658 | April 10, 2026 Page 10 of 11 Conclusion [25] Dr. Gallo conducted an individualized assessment of L.F.’s condition, testified

to his honest belief that Abilify would stabilize her schizophrenia, addressed her

specific concern about sedative side effects, and weighed the benefits of the

medication against the risks of side effects and risks of non-treatment. He also

considered and rejected alternative treatment options. The trial court’s

determination that L.F.’s commitment was appropriate is supported by clear

and convincing evidence. We therefore affirm.

Brown, J., and Foley, J., concur.

ATTORNEY FOR APPELLANT Sarah Medlin Marion County Public Defender Agency Indianapolis, Indiana

ATTORNEYS FOR APPELLEE Bryan H. Babb Seema R. Shah Bose McKinney & Evans LLP Indianapolis, Indiana

Court of Appeals of Indiana | Opinion 26A-MH-658 | April 10, 2026 Page 11 of 11