In the Matter of the Commitment of S.W. v. Columbus Regional Hospital Mental Health Center (mem. dec.)

MEMORANDUM DECISION FILED Pursuant to Ind. Appellate Rule 65(D), Nov 14 2017, 10:20 am this Memorandum Decision shall not be regarded as precedent or cited before any CLERK Indiana Supreme Court court except for the purpose of establishing Court of Appeals and Tax Court

the defense of res judicata, collateral estoppel, or the law of the case.

ATTORNEY FOR APPELLANT ATTORNEY FOR APPELLEE James A. Shoaf Steven J. Cohen Columbus, Indiana Zeigler Cohen & Koch Indianapolis, Indiana

IN THE COURT OF APPEALS OF INDIANA

In the Matter of the November 14, 2017 Commitment of S.W., Court of Appeals Case No. Appellant-Respondent, 03A04-1706-MH-1344 Appeal from the Bartholomew v. Superior Court The Honorable James D. Worton, Columbus Regional Hospital Judge Mental Health Center, Trial Court Cause No. Appellee-Petitioner. 03D01-1705-MH-2984

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STATEMENT OF THE CASE [1] Appellant-Respondent, S.W., appeals the trial court’s grant of Appellee-

Petitioner’s, Columbus Regional Hospital Mental Health Center (Columbus

Regional Hospital), request for regular commitment. [2] We affirm.

ISSUE [3] S.W. raises one issue for our review, which we restate as: Whether Columbus

Regional Hospital presented sufficient evidence to support the trial court’s order

of regular commitment.

FACTS AND PROCEDURAL HISTORY [4] S.W., fifty-five years old at the time of the trial court proceedings, has a history

of mental illness and has previously been diagnosed with schizophrenia and

schizoaffective disorder. She attempted suicide in December 2013 after refusing

to take her medication and experiencing severe auditory hallucinations. Since

2014, S.W. has been admitted at the Columbus Regional Hospital on five

different occasions and has previously been placed under a temporary

commitment order. [5] On May 26, 2017, S.W. was admitted to the mental health unit at Columbus

Regional Hospital, after S.W.’s daughter had sought emergency detention of

her at Centerstone treatment facility due to concerns that S.W. had started

experiencing auditory hallucinations and had become paranoid. S.W. had

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become delusional in believing that her neighbors had been coming into her

home, poisoning her food, threatening her, and taking her clothes and money.

She also believed that she was five months pregnant with twins fathered by

“Joseph from the Bible.” (Transcript p. 25). S. W. described her auditory

hallucinations “as angels talking to her.” (Tr. p. 25). She used her pregnancy

as a reason for her refusal to take her medications. [6] That same day, May 26, 2017, Columbus Regional Hospital completed an

application for emergency detention of a mentally ill and dangerous person,

alleging that S.W. was believed to be a person suffering from a psychiatric

disorder, who was dangerous to herself because she was “delusional, psychotic,

[and a] risk to herself,” and that if not immediately restrained, she “would harm

herself.” (Appellant’s App. Vol. II, p. 43). The application was accompanied

by a physician’s emergency statement, signed by S.W.’s in-patient psychiatrist,

Dr. Michael Stark (Dr. Stark). Dr. Stark opined that, based on his examination

of S.W., S.W. “may be mentally ill and dangerous” and diagnosed her as being

“delusional.” (Appellant’s App. Vol. II, p. 44). She “believed neighbors were

breaking into her apartment and poisoning her food, worried she was being

poisoned at the hospital, and believed she was pregnant.” (Appellant’s App.

Vol. II, p. 44). Based on the application and Dr. Stark’s physician’s statement,

S.W. was detained at the Columbus Regional Hospital on an emergency basis. [7] Also on May 26, 2016, Columbus Regional Hospital filed a report following

emergency detention with the trial court, supported by a physician’s statement

completed by Dr. Stark. Upon examining S.W., Dr. Stark opined that S.W.

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suffered from schizoaffective disorder which made her dangerous to herself.

Dr. Stark referred to S.W.’s “history of attempting suicide when not compliant

with psychiatric meds and auditory hallucinations [which became] predictably

worse.” (Appellant’s App. Vol. II, p. 41). Despite two negative pregnancy

tests, S.W. continued to believe that she was pregnant and insisted that she felt

movement in her stomach. Dr. Stark concluded that S.W. had experienced “a

substantial impairment or obvious deterioration in judgment, reasoning, or

behavior that resulted” in her inability to function independently. (Appellant’s

App. Vol. II, p. 41). Dr. Stark again noted her history of attempting suicide

when not compliant with her psychiatric medication and worsening auditory

hallucinations. He opined that S.W. was in need of custody, care or treatment

in an appropriate facility and that outpatient services would not be adequate as

S.W. could not be relied upon to take her medication. According to the

statement, Dr. Stark had discussed with S.W. “the advisability of obtaining

treatment on a voluntary basis,” which she had refused. (Appellant’s App. Vol.

II, p. 42). Therefore, Dr. Stark suggested a regular commitment with an initial

inpatient admission until antipsychotic medication could be initiated and

S.W.’s condition could be stabilized. [8] On June 1, 2017, the trial court conducted a regular commitment hearing,

during which testimony was received from Dr. Stark and S.W. At the

completion of the hearing, the trial court issued an Order of regular

commitment, finding that S.W. suffered from a mental illness, as defined by

Ind. Code § 12-7-2-130(1), that she was dangerous to herself, in accordance

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with I.C. § 12-7-2-53, and that she was gravely disabled, pursuant to I.C. § 12-7-

2-96. The trial court concluded that S.W. was in need of commitment for a

period expected to exceed ninety days and that the appropriate facility where

she could receive rehabilitative treatment or rehabilitation and care was as an

inpatient at the Columbus Regional Hospital until stabilization, with transition

to outpatient services through Centerstone. The trial court authorized the staff

at Columbus Regional Hospital to administer whatever treatment was deemed

necessary for S.W., with or without her consent. [9] S.W. now appeals. Additional facts will be provided if necessary.

DISCUSSION AND DECISION [10] S.W. contends that the trial court abused its discretion in ordering a regular

commitment because the evidence supports that S.W.’s commitment is not

“reasonably expected to require custody, care or treatment in a facility for more

than ninety days.” See I.C. § 12-26-7-1(2). [11] The 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

Roberts, 723 N.E.2d 474, 476 (Ind. Ct. App. 2000). 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. See Addington v. Texas, 441 U.S. 418, 426-

26, 99 S.Ct. 1804, 60 L.Ed.2d 323 (1979). To satisfy these requirements of due

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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 attached to a decision ordering an involuntary

commitment, but . . . also has the function of reducing the chance of

inappropriate commitments.” Commitment of J.B. v. Midtown Mental Health Ctr.,

581 N.E.2d 448, 450 (Ind. Ct. App. 1991), trans. denied. [12] In reviewing the sufficiency of the evidence supporting a determination made

under the statutory requirement of clear and convincing evidence, an appellate

court 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.” Civil Commitment of T.K. v. Department of

Veteran Affairs, 27 N.E.3d 271, 273 (Ind. 2015). [13] Accordingly, the issue presented in this case is whether, considering the

probative evidence and reasonable inferences favorable to the judgment, the

trial court could have found by clear and convincing evidence that S.W. was

either dangerous or gravely disabled. “Dangerous” is “a condition in which an

individual as a result of mental illness, presents a substantial risk that the

individual will harm the individual or others.” I.C. § 12-7-2-53. “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:

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(1) Is unable to provide for that individual’s food, clothing, shelter, or other essential human needs; or

(2) Has a substantial impairment or obvious deterioration of that individual’s judgment, reasoning, or behavior that results in the individual’s inability to function independently.

I.C. § 12-7-2-96. [14] S.W. does not challenge the trial court’s finding that she is mentally ill,

dangerous, or gravely disabled. Rather, the crux of the case is whether

Columbus Regional Hospital presented sufficient evidence to support its

allegation that S.W. “is in need of commitment to an appropriate facility for . . .

a period expected to exceed ninety days.” She maintains that the “evidence

presented at the hearing was that within a few days of the hearing, S.W. would

be released from the facility to outpatient services.” (Appellant’s Br. pp. 8-9). [15] The first time that a person is subjected to a commitment proceeding, a trial

court may only order temporary commitment of the person, which cannot

exceed ninety days. See I.C. §§ 12-26-5-11(c); -6-1. However, the evidence

reflects that S.W. had been under a previous commitment order in 2014 and

therefore, “a trial court may order a regular commitment, which can be of

indefinite length.” See I.C. §§ 12-26-5-11(d); -7-5. Specifically, the regular

commitment continues

until any of the following occurs: (1) The individual had been: (A) Discharged from the facility; or

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(B) Released from the therapy program. (2) The court enters an order: (A) Terminating the commitment; or (B) Releasing the individual from the therapy program. I.C. § 12-26-7-5(b).

[16] Testifying about S.W.’s treatment plan and least restrictive placement, Dr.

Stark explained that due to S.W.’s history of suicide attempts when not taking

her medicine, her poor compliance with her medication regime, and her lack of

insight into her diagnosis, he “would like to get her on a depo, long acting

monthly injectable.” (Tr. p. 7). Then, “hopefully stabilize her with that and

then discharge her home with outpatient services through Centerstone.” (Tr. p.

8). Dr. Stark clarified that “[i]t would probably [be] four days to, to properly

administer that. It would probably require two shots.” (Tr. p. 9). “And

assuming that her symptoms improve with that, you know four or five days, I

think would be a reasonable time frame going forward.” (Tr. p. 9). S.W.

would then be required to go into Centerstone and get a monthly shot. Dr.

Stark elaborated that if she was not compliant with the monthly injection

schedule, she could potentially be re-admitted to Columbus Regional Hospital

“to ensure that she should stay on the medicine.” (Tr. p. 10). [17] Accordingly, in light of S.W.’s previous temporary commitment, the trial court

properly ordered regular commitment of S.W. Based on Dr. Stark’s testimony,

clear and convincing evidence supports that S.W.’s entire treatment plan

consists of an inpatient hospital stay, combined with an outpatient therapy

component. Although the initial admission at Columbus Regional Hospital is

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short in duration, S.W.’s monthly participation at Centerstone is a crucial

element for the continued success of her treatment and will encompass

numerous months, exceeding the ninety day period, as envisioned in the regular

commitment order. Therefore, we affirm the trial court’s regular commitment

order.

CONCLUSION [18] Based on the foregoing, we conclude that Columbus Regional Hospital

presented clear and convincing evidence to support the regular commitment

order. [19] Affirmed. [20] Robb, J. and Pyle, J. concur

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