In re the Civil Commitment of C.B. v. Eskenazi Health Midtown Community Mental Health (mem. dec.)

• Court: Indiana Court of Appeals
• Decided: May 4, 2017
• Docket: 49A04-1606-MH-1256
• Status: Published

Opinion

MEMORANDUM DECISION

Pursuant to Ind. Appellate Rule 65(D), FILED this Memorandum Decision shall not be regarded as precedent or cited before any May 04 2017, 8:20 am

court except for the purpose of establishing CLERK Indiana Supreme Court the defense of res judicata, collateral Court of Appeals and Tax Court estoppel, or the law of the case.

ATTORNEY FOR APPELLANT ATTORNEYS FOR APPELLEE Darren Bedwell Phyllis J. Garrison Marion County Public Defender Eskenazi Health Indianapolis, Indiana Indianapolis, Indiana

IN THE COURT OF APPEALS OF INDIANA

In re the Civil Commitment of May 4, 2017 C.B., Court of Appeals Case No. Appellant-Respondent, 49A04-1606-MH-1256 Appeal from the Marion Superior v. Court, Probate Division The Honorable Steven R. Eskenazi Health Midtown Eichholtz, Judge Community Mental Health, Trial Court Cause No. Appellee-Petitioner 49D08-1605-MH-17646

Mathias, Judge.

[1] C.B. appeals the Marion Superior Court’s order involuntarily committing him

to the Health & Hospital Corporation of Marion County d/b/a Eskenazi

Health Midtown Community Mental Health (“Eskenazi Health”) for a period

Court of Appeals of Indiana | Memorandum Decision 49A04-1606-MH-1256 | May 4, 2017 Page 1 of 9 not expected to exceed ninety days. Concluding that the temporary

commitment order is supported by clear and convincing evidence, we affirm.

Facts and Procedural History

[2] C.B. is a 72-year-old retired science teacher. On an unknown date in mid-May

2016, C.B. was found in an alleyway and told a police officer that he was

“working on a government program to import Russian women.” Tr. p. 9. He

was taken to Methodist Hospital in Indianapolis but was not detained.

[3] On May 16, 2016, C.B. called 911 to report that an FBI agent had been killed.

Police officers found no evidence that C.B.’s report was accurate. C.B. was

admitted to Eskenazi Health’s Crisis Intervention Unit that night but was

released. The next day, May 17, 2016, a police officer took C.B. to Eskenazi

Health, and he was admitted because he was “very delusional.” Tr. p. 8.

[4] On May 18, 2016, Eskenazi Health filed an application for emergency

detention. Shortly thereafter, it filed a report and physician’s statement alleging

that C.B. suffered from an “unspecified psychotic disorder” and that he was

gravely disabled. Appellant’s App. pp. 12-16. The trial court held a hearing on

Eskenazi’s application on May 26, 2016.

[5] Dr. Thomas Beesley, a psychiatry resident, testified that C.B. reported that he

was a member of the FBI and he needed to be released from the hospital to go

to orientation. C.B. also told the doctor that he was “an elite member of the

Republican Party” and the party was working “diligently” to get C.B. out of the

hospital. Tr. p. 9. C.B. told numerous individuals that he was the President- Court of Appeals of Indiana | Memorandum Decision 49A04-1606-MH-1256 | May 4, 2017 Page 2 of 9 elect of the United States. C.B. also stated to numerous Eskenazi Health

employees that he was recommending them for cabinet positions. Tr. p. 10.

[6] After reviewing C.B.’s medical records and examining him, Dr. Beesley

concluded that C.B. suffers from a psychotic disorder. Dr. Beesley also believed

that C.B. was homeless because C.B. gave the doctor several different

explanations for his lack of housing and his living situation if he were

discharged from the hospital. Id. Dr. Beesley opined that C.B. is gravely

disabled because he does not understand his mental illness, cannot function

independently, and will not follow up on his treatment plan.

[7] Dr. Beesley prescribed Risperdal, but also discovered that C.B. has a vitamin

B12 deficiency that is likely triggering his psychosis. Tr. p. 12. In addition, “B12

deficiency can cause more severe symptoms. Mainly neurologic symptoms

which can progress theoretically to the point of death.” Tr. p. 14. Dr. Beesley

started C.B. on “IM B12 replacement” injections, and C.B. was willing to take

those. Tr. p. 15. Dr. Beesley stated that C.B. would need the injections for up to

fourteen days. Treatment on an out-patient basis was possible but “the

discharge plans that C.B. [] proposed ha[d] all been delusional based.” Tr. p.

16.

[8] Dr. Beesley did not believe that C.B. would voluntarily continue his treatment

plan.

I believe his inability to cooperate and to have medical decision making capacity is all directly related to his psychosis and his delusional beliefs. And with that being said, even with the B12 Court of Appeals of Indiana | Memorandum Decision 49A04-1606-MH-1256 | May 4, 2017 Page 3 of 9 replacement, it’s clear there are other medical conditions going on and he’s not allowing us to work those medical conditions up. And it is possible that the psychosis won’t improve with the B12 injections because it’s being caused by another medical condition.

Tr. pp. 16-17. The doctor also expressed the need for C.B. “to have housing and

[a] stable environment where we could . . . have him actually come back for

clinic appointments. And get subsequent B12 injections.” Tr. p. 18.

[9] C.B. did not agree with Dr. Beesley’s diagnosis and wanted a second opinion

from a doctor at St. Vincent’s Hospital. C.B. believed that Dr. Beesley was a

poor doctor who needed money, who “is trying to achieve more status so he

can do . . . more intrusions into my body that are not necessary.” Tr. p. 38.

[10] C.B.’s testimony at the commitment hearing also established that on May 17,

2016, the date he was admitted to Eskenazi, he did not have stable housing. Tr.

pp. 34-35 (explaining that the day he was detained he was trying to find a safe

place to stay for the night). C.B. still suffered from delusions at the hearing and

continued to believe that the FBI had a certificate, badge, gun, and holster

waiting for him but he had not had training yet. Tr. pp. 36-37. C.B. could not

recall placing a 911 call claiming that an FBI agent had been shot. C.B. also

testified that the Republican Party was going to employ him and give him a

gun, badge, and holster. Tr. p. 53. He testified that the Republican Party was

preparing him to run for president in four years. Tr. p. 56. Finally, C.B. said he

receives a social security check each month and stated that if he was released

Court of Appeals of Indiana | Memorandum Decision 49A04-1606-MH-1256 | May 4, 2017 Page 4 of 9 from the hospital he could stay with a friend who lives in Kokomo or possibly

near his brother in Crown Point.

[11] After the hearing and argument by the parties, the trial court issued an order of

temporary commitment of C.B. The court concluded that C.B. was gravely

disabled as defined in Indiana Code section 12-7-2-96. Appellant’s App. p. 8.

C.B. was committed until August 24, 2016 “unless discharged prior.” Id. C.B.

appeals the order of temporary commitment.

Discussion and Decision

[12] C.B.’s appeal of his involuntary commitment is moot because he was

committed to Eskenazi Health until August 24, 2016 “unless discharged prior”

to that date. Appellant’s App. p. 8. In general, “[w]hen a court is unable to

render effective relief to a party, the case is deemed moot and usually

dismissed.” In re J.B., 766 N.E.2d 795, 798 (Ind. Ct. App. 2002) (citing In re

Lawrance, 579 N.E.2d 32, 37 (Ind. 1991)). However, our courts “have long

recognized that a case may be decided on its merits under an exception to the

general rule when the case involves questions of ‘great public interest.’” In re

Lawrance, 579 N.E.2d at 37. Typically, cases falling in the “great public

interest” exception contain issues likely to recur. Id.; see Ind. High Sch. Athletic

Ass'n, Inc. v. Durham, 748 N.E.2d 404, 412 (Ind. Ct. App. 2001) (“Although

Indiana does not require that the issue be capable of repetition, cases falling into

the public interest exception usually involve issues that are likely to recur.”).

Court of Appeals of Indiana | Memorandum Decision 49A04-1606-MH-1256 | May 4, 2017 Page 5 of 9 [13] Involuntary commitment of otherwise free individuals in the United States is an

issue of great importance to society. In other countries, mental health

commitments are misused, often for political purposes. Indiana statutory and

case law affirm that the value and dignity of the individual facing commitment

or treatment is of great societal concern. See Ind. Code § 12-26-5-1 (establishing

procedures for seventy-two-hour commitment); Ind. Code § 12-26-6-2

(establishing procedures for ninety-day commitment); In re Mental Commitment

of M.P., 510 N.E.2d 645, 646 (Ind. 1987) (noting that the statute granting a

patient the right to refuse treatment “profoundly affirms the value and dignity

of the individual and the commitment of this society to insuring humane

treatment of those we confine”). Because the instant case involves the proof

necessary for involuntary commitment, an issue of great public importance

which will recur, we address it here. See In re J.B., 766 N.E.2d at 798-99.

[14] C.B. claims that the trial court’s order allowing for his involuntary commitment

is not supported by clear and convincing evidence. In Civil Commitment of T.K. v.

Dep’t of Veterans Affairs, 27 N.E.3d 271 (Ind. 2015), our supreme court

explained, “[t]o obtain an involuntary regular commitment of an individual, a

‘petitioner is required to prove by clear and convincing evidence that: (1) the

individual is mentally ill and either dangerous or gravely disabled; and (2)

detention or commitment of that individual is appropriate.” Id. at 273 (quoting

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

[T]he purpose of civil commitment proceedings is dual: to protect the public and to ensure the rights of the person whose liberty is

Court of Appeals of Indiana | Memorandum Decision 49A04-1606-MH-1256 | May 4, 2017 Page 6 of 9 at stake. 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.”

Id. (internal citations omitted).

[15] C.B. concedes that he is mentally ill but argues that Eskenazi Health did not

present clear and convincing evidence that he was gravely disabled.1 “Gravely

disabled” is defined 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.

1 The trial court did not find that C.B. was dangerous to himself or others, only that he was gravely disabled. Appellant’s App. p. 8.

Court of Appeals of Indiana | Memorandum Decision 49A04-1606-MH-1256 | May 4, 2017 Page 7 of 9 Ind. Code § 12-7-2-96. “[D]enial of illness and refusal to medicate, standing

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.’” T.K., 27 N.E.3d at 276 (quoting I.C. § 12-

7-2-96).

[16] C.B. was not malnourished and did not exhibit poor hygiene when he was

admitted to Eskenazi Health on May 17, 2016. In addition, he has monthly

social security income sufficient to support himself. However, Dr. Beesley

believed that C.B. was homeless because C.B. made several different statements

concerning his lack of housing and his living situation if he were discharged

from the hospital. C.B.’s testimony at the hearing also established that on May

17, 2016, he did not have stable housing. Tr. pp. 34-35.

[17] Dr. Beesley believes that C.B. needs “housing and [a] stable environment where

we could . . . have him actually come back for clinic appointments. And get

subsequent B12 injections.” Tr. p. 18. At the hearing, the doctor expressed

concern that C.B. does not understand his mental illness, cannot function

independently, and would not follow up with his treatment plan. During the

week prior to his May 17, 2016 admission to Eskenazi Health, C.B. was twice

taken to hospitals by police officers. On May 17, the third time C.B. was

transported to a hospital in approximately one week, he was delusional and

lacked housing. At the time he presented, C.B. clearly satisfied both definitions

of grave disability under the statue, when only one is required for commitment.

Court of Appeals of Indiana | Memorandum Decision 49A04-1606-MH-1256 | May 4, 2017 Page 8 of 9 To us, it is clear that C.B. needed a structured environment for a moderate

period of time to stabilize his medical and psychiatric conditions and to allow

doctors to properly assess his course of treatment going forward. Judge

Eichholtz’s order was creatively and appropriately limited to solve the problem

before him.

[18] For these reasons, we conclude that clear and convincing evidence supports the

trial court’s finding that C.B. was gravely disabled as defined by Indiana Code

section 12-7-2-96. We therefore affirm the trial court’s order of temporary

commitment.

[19] Affirmed.

Baker, J., and Pyle, J., concur.

Court of Appeals of Indiana | Memorandum Decision 49A04-1606-MH-1256 | May 4, 2017 Page 9 of 9