In the Matter of the Civil Commitment of R.J. v. Richard L. Roudebush Veterans Affairs Medical Center (mem. dec.)

• Court: Indiana Court of Appeals
• Decided: June 5, 2015
• Docket: 49A04-1411-MH-539
• Status: Published

Opinion

MEMORANDUM DECISION Pursuant to Ind. Appellate Rule 65(D), this Jun 05 2015, 11:41 am Memorandum Decision shall not be regarded as precedent or cited before any court except for the purpose of establishing the defense of res judicata, collateral estoppel, or the law of the case.

ATTORNEY FOR APPELLANT ATTORNEY FOR APPELLEE Valerie K. Boots Chadwick C. Duran Marion County Public Defender Agency U.S. Department of Veterans Affairs Indianapolis, Indiana Indianapolis, Indiana

IN THE COURT OF APPEALS OF INDIANA

In the Matter of the Civil June 5, 2015 Commitment of R.J., Court of Appeals Case No. 49A04-1411-MH-539 Appellant-Respondent, Appeal from the Marion Superior v. Court The Honorable Gerald Zore, Judge Richard L. Roudebush Veterans Case No. 49D08-1410-MH-33327 Affairs Medical Center, Appellee-Petitioner,

Vaidik, Chief Judge.

Court of Appeals of Indiana | Memorandum Decision 49A04-1411-MH-539 | June 5, 2015 Page 1 of 10 Case Summary [1] R.J. appeals from the Marion Superior Court’s order involuntarily committing

him to the Richard L. Roudebush Veterans Affairs Medical Center (VAMC).

He contends that his involuntary commitment is not supported by clear and

convincing evidence. Specifically, he disputes the trial court’s determination

that: 1) he was mentally ill; 2) he was a danger to himself; and 3) his

commitment to VAMC was appropriate. But the record shows that R.J., who

was suffering from major depressive disorder, attempted suicide twice in the

three months before his commitment, and was threatening to shoot himself

with a handgun on the night before his commitment. At the commitment

hearing, R.J.’s doctor testified that his commitment was absolutely necessary

due to his suicidal history. This evidence is sufficient to support the trial court’s

involuntary-commitment order. We affirm.

Facts and Procedural History [2] R.J. is a medical doctor and veteran of the United States Air Force. After his

military service—which included a three-month deployment to Iraq—ended,

R.J. practiced medicine at several federal prisons in Texas. R.J. had difficulty

sleeping and took medication for depression. Tr. p. 52.

[3] R.J.’s wife filed for divorce in summer 2014. Id. at 36. In July 2014 R.J.

attempted suicide by consuming six bottles of opiates. Id. at 7, 39. He “very

nearly died” and was on a ventilator for three days. Id. When he recovered,

Court of Appeals of Indiana | Memorandum Decision 49A04-1411-MH-539 | June 5, 2015 Page 2 of 10 R.J. moved to Indiana to be near family. He began working at Rockville

Correctional Facility, but he was fired a short time later. On September 24,

2014, R.J. was treated at an urgent-care facility for suicidal ideations after

expressing his plan to drive his car into a river. Id. at 7. Four days later, R.J.

was hospitalized for three days after he took “too many pills.” Id. at 7, 28, 42.

[4] On the evening of Saturday, October 18, 2014, R.J. was having “some intense

emotions” about his wife and young son. Id. at 50. R.J. was “feeling down”

and “firing a shotgun” into nearby woods. Id. at 51. He later went to a bar,

where he began sending text messages to family members, including his

stepfather, saying that “the gun was too long, couldn’t do the job,” and “I’m

going to use a handgun either to the head, or to my chest.” Id. at 41. His

stepfather went to the bar to speak to R.J., who was “drinking heavily.” Id.

R.J. refused to speak to his stepfather, and R.J. left the bar in his car, driving “a

100 mile[s per] hour.” Id. Police later located R.J. and took him to Terre

Haute Regional Hospital.

[5] On Sunday, October 19, 2014, a hospital social worker completed an

Application for Emergency Detention of Mentally Ill and Dangerous Person.

Appellant’s App. p. 17-18. The application was accompanied by a statement

from Dr. Surjit Singh. Id. at 18. Dr. Singh asserted that R.J. was “at a high risk

of committing suicide, multiple attempts [and] has intention of suicide

completion by handgun.” Id. R.J. was then transferred to VAMC, and VAMC

employees filed the emergency-detention application on Monday, October 20,

2014.

Court of Appeals of Indiana | Memorandum Decision 49A04-1411-MH-539 | June 5, 2015 Page 3 of 10 [6] Upon his arrival at VAMC, R.J. was examined by two physicians—Susan

Conroy and Paula Mathewson. Dr. Conroy completed a Report Following

Emergency Detention. Id. at 20-24. The report indicated that R.J. suffered

from major depressive disorder and posed a substantial risk to himself because

he “made several serious suicide attempts in the past month and states his

intention to kill himself as soon as he is let out of the hospital.” Id. at 22-23.

[7] The trial court held a commitment hearing on October 28, 2014. Dr. Conroy

testified that when R.J. came to VAMC, he refused to eat or drink for two days,

and would not speak to any staff. Tr. p. 6. Dr. Conroy diagnosed R.J. with

major depressive disorder based on “the thoughts of death and suicide, trouble

sleeping. Um kind of feelings of guilt[] about things that have gone wrong,

those are all symptoms of depression.” Id. at 10. She testified about R.J.’s

previous suicide attempts and explained that R.J.’s divorce was “probably the

main trigger for all of this.” Id. at 7. Dr. Conroy planned to treat R.J. with

psychotherapy but believed that inpatient treatment was “absolutely necessary,”

and that she “had no choice[] but to commit him . . . we seriously believed that

he [would] commit suicide.” Id. at 8.

[8] At the conclusion of the hearing, the trial court ordered R.J. committed to

VAMC’s custody for a period not to exceed ninety days.1 In its written order,

1 R.J.’s involuntary-commitment term has expired, and he has been released from VAMC’s custody. Generally, we dismiss cases that are moot, but a moot case may be decided on its merits when it involves questions of great public interest, such as involuntary commitment, that are likely to recur. A.L. v. Wishard

Court of Appeals of Indiana | Memorandum Decision 49A04-1411-MH-539 | June 5, 2015 Page 4 of 10 the court found that R.J. was “suffering from major depressive disorder, which

is a mental illness as defined in [Indiana Code section] 12-7-2-130,” and was a

danger to himself as defined by statute. Appellant’s App. p. 20.

[9] R.J. now appeals.

Discussion and Decision [10] R.J. argues that his involuntary commitment is not supported by clear and

convincing evidence. Specifically, he disputes the trial court’s determination

that: 1) he was mentally ill; 2) he was a danger to himself; and 3) his

commitment was appropriate.

[11] In Indiana, a person may be involuntarily committed if the petitioner proves 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.” Ind. Code § 12-26-2-5(e). “[T]he purpose of civil

commitment proceedings is dual: to protect the public and to ensure the rights

of the person whose liberty is at stake.” In re Commitment of T.K., 27 N.E.3d

271, 273 (Ind. 2015) (citation omitted). “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

Health Servs., Midtown Cmty. Mental Health Ctr., 934 N.E.2d 755, 758 (Ind. Ct. App. 2010), trans. denied. We therefore consider R.J.’s appeal on the merits.

Court of Appeals of Indiana | Memorandum Decision 49A04-1411-MH-539 | June 5, 2015 Page 5 of 10 physical confinement, a proceeding for an involuntary civil commitment is

subject to due process requirements.” Id. (citing Addington v. Texas, 441 U.S.

418, 425-26 (1979)). The clear-and-convincing standard “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. (citation omitted). When

reviewing a challenge to the sufficiency of the evidence with respect to a

commitment proceeding, we will 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] proven by clear and convincing evidence.” Id.

1. Mental Illness [12] R.J. first challenges the trial court’s determination that he was mentally ill. See

Appellant’s App. p. 14-16. Indiana Code section 12-7-2-130 defines mental

illness as “a psychiatric disorder that . . . substantially disturbs an individual’s

thinking, feeling, or behavior . . . and impairs the individual’s ability to

function.” Ind. Code § 12-7-2-130(1).

[13] Dr. Conroy diagnosed R.J. with major depressive disorder, characterized by

“the thoughts of death and suicide, trouble sleeping. Um kind of feelings of

guilt[] about things that have gone wrong, those are all symptoms of

depression.” Tr. p. 10. R.J. does not dispute that major depressive disorder is a

mental illness as defined by statute. Rather, he disputes the accuracy of Dr.

Court of Appeals of Indiana | Memorandum Decision 49A04-1411-MH-539 | June 5, 2015 Page 6 of 10 Conroy’s diagnosis by noting that she only recently graduated from medical

school, spent only twenty minutes each day with him during his

hospitalization, and only testified about four symptoms of major depressive

disorder, despite the fact that “major depressive disorder requires a minimum of

five symptoms of depression.” Appellant’s App. p. 14.

[14] With respect to Dr. Conroy’s qualifications and the amount of time she spent

with R.J. before diagnosing him, these issues go to the doctor’s credibility—an

issue to be determined by the trier of fact, not this Court. As for the fact that

Dr. Conroy cited four, not five, symptoms of major depressive disorder, this is

not reversible error. Section 12-7-2-130 does not require enumeration of a

specific number of mental-illness symptoms before a trial court may find that an

individual is mentally ill. Here, Dr. Conroy’s testimony about R.J.’s suicidal

history, thoughts of death and suicide, trouble sleeping, and feelings of guilt

was sufficient. Although R.J. claims that some of his symptoms, such as

difficulty sleeping, predated his hospitalization and thus are not reliable

indicators of major depressive disorder, this is an invitation to reweigh the

evidence, which we may not do. The trial court did not err in concluding that

R.J. was mentally ill.

2. Dangerousness [15] R.J. next challenges the trial court’s conclusion that he was dangerous at the

time of the commitment hearing. For involuntary-commitment purposes,

“dangerous” is defined as “a condition in which an individual as a result of

Court of Appeals of Indiana | Memorandum Decision 49A04-1411-MH-539 | June 5, 2015 Page 7 of 10 mental illness, presents a substantial risk that the individual will harm the

individual or others.” Ind. Code § 12-7-2-53. “Dangerousness must be shown

by clear and convincing evidence indicating that the behavior used as an index

of a person’s dangerousness would not occur but for that person’s mental

illness.” In re Commitment of C.A., 776 N.E.2d 1216, 1218 (Ind. Ct. App.

2002).

[16] Here, R.J.’s behavior strongly supports the trial court’s determination that he

was dangerous: in the three months leading up to his commitment, R.J.

attempted suicide twice by consuming pills, and he was also treated at an

urgent-care facility for suicidal ideations after expressing his plan to drive his

car into a river. On the night before he was committed, R.J. was “feeling

down” and “firing a shotgun” into nearby woods. Tr. p. 51. He later went to a

bar, where he began sending text messages to family members, including his

stepfather, saying that “the gun was too long, couldn’t do the job,” and “I’m

going to use a handgun either to the head, or to my chest.” Id. at 41. His

stepfather went to the bar to speak to R.J., who was “drinking heavily.” Id.

R.J. refused to speak to his stepfather, and R.J. left the bar in his car, driving “a

100 mile[s per] hour.” Id. This is sufficient evidence that R.J. posed a

substantial risk of harm to himself and thus, was dangerous.

[17] R.J. argues that the trial court found only that he might pose a danger to

himself. See Appellant’s Br. p. 17-18. R.J.’s claim is based on the trial court’s

comment at the conclusion of the commitment hearing that “[R.J.] maybe [sic]

dangerous to himself . . . .” Tr. p. 67. But as R.J. acknowledges, the trial

Court of Appeals of Indiana | Memorandum Decision 49A04-1411-MH-539 | June 5, 2015 Page 8 of 10 court’s commitment order clearly states its finding that “[R.J.] is dangerous to

self . . . .” Appellant’s App. p. 7. From this we can conclude that the trial court

made the statutorily required finding that R.J. was dangerous.

3. Appropriateness [18] Finally, R.J. challenges the appropriateness of his commitment to VAMC. In

order for a court to involuntarily commit an individual under Indiana Code

section 12-26-2-5(e), the commitment must be appropriate. The determination

of whether an involuntary commitment is appropriate is fact-sensitive. In re

Commitment of R.P., 26 N.E.3d 1032, 1037 (Ind. Ct. App. 2015) (citation

omitted).

[19] Here, the record clearly establishes R.J.’s suicidal history. After diagnosing

R.J. with major depressive disorder, Dr. Conroy developed a plan to treat him

with psychotherapy. Tr. p. 7. At the commitment hearing she stated that she

believed that inpatient treatment was “absolutely necessary,” and that she “had

no choice[] but to commit him . . . we seriously believed that he [would]

commit suicide.” Id. at 8. On appeal, R.J. argues that he could have

participated in psychotherapy in an outpatient setting, which would have

allowed him to stay abreast of his divorce proceedings and ongoing job search.

See Appellant’s App. p. 12-14. R.J. also contends that “the record shows that

[he] was no longer suicidal.” Id. at 14. But in light of R.J.’s repeated suicide

attempts and his doctor’s unequivocal opinion that he would in fact commit

Court of Appeals of Indiana | Memorandum Decision 49A04-1411-MH-539 | June 5, 2015 Page 9 of 10 suicide if not committed, we cannot say that the trial court erred in determining

that R.J.’s temporary commitment to VAMC was appropriate.

Affirmed.

Kirsch, J., and Bradford, J., concur.

Court of Appeals of Indiana | Memorandum Decision 49A04-1411-MH-539 | June 5, 2015 Page 10 of 10