In the Matter of the Civil Commitment of B.N. B.N. v. Community Health Network, Inc.

FILED Dec 20 2019, 5:27 am

CLERK Indiana Supreme Court Court of Appeals and Tax Court

ATTORNEY FOR APPELLANT ATTORNEYS FOR APPELLEE Megan Shipley Jenny R. Buchheit Marion County Public Defender’s Stephen E. Reynolds Agency Sean T. Dewey Indianapolis, Indiana Ice Miller LLP Indianapolis, Indiana

IN THE COURT OF APPEALS OF INDIANA

In the Matter of the Civil December 20, 2019 Commitment of B.N.; Court of Appeals Case No. 19A-MH-1037 B.N., Appeal from the Marion Superior Appellant-Respondent, Court v. The Honorable Kelly Scanlan, Judge Pro Tempore Community Health Network, Trial Court Cause No. Inc., 49D08-1904-MH-13007

Appellee-Petitioner. Pyle, Judge. Court of Appeals of Indiana | Opinion 19A-MH-1037 | December 20, 2019 Page 1 of 15

Statement of the Case [1] B.N. (“B.N.”) appeals the trial court’s order for his involuntary temporary

commitment1 to Community Health Network, Inc. (“the Hospital”) for a period

not to exceed ninety days. B.N. argues that the trial court violated his due

process right of having the Hospital meet its burden of proving the elements of

the involuntary commitment by clear and convincing evidence. Specifically, he

contends that the trial court violated this due process right when it ordered him

to an involuntary temporary commitment based in part on his own testimony

given during the commitment hearing. He also argues that the Hospital did not

prove by clear and convincing evidence that the commitment was appropriate.

Concluding that there was no due process violation and that B.N.’s sufficiency

argument is nothing more than a request to reweigh the evidence, we affirm the

trial court’s involuntary temporary commitment order. [2] We affirm.

1 In Civil Commitment of T.K. v. Dep't of Veterans Affairs, 27 N.E.3d 271, 273 n. 1 (Ind. 2015), the Indiana Supreme Court explained:

In Indiana, an adult person may be civilly committed either voluntarily or involuntarily. Involuntary civil commitment may occur under four circumstances if certain statutorily regulated conditions are satisfied: (1) “Immediate Detention” by law enforcement for up to 24 hours; (2) “Emergency Detention” for up to 72 hours; (3) “Temporary Commitment” for up to 90 days; and (4) “Regular Commitment” for an indefinite period of time that may exceed 90 days. (internal citations omitted).

Court of Appeals of Indiana | Opinion 19A-MH-1037 | December 20, 2019 Page 2 of 15

Issue Whether the trial court’s order for an involuntary commitment complied with B.N.’s due process right and is supported by sufficient evidence.

Facts [3] On March 28, 2019, sixty-two-year-old B.N. was admitted to the Hospital

through its crisis department and was examined by psychiatrist Dr. Syed Hasan

(“Dr. Hasan”). Thereafter, Dr. Hasan, on behalf of the Hospital, filed an

application for the emergency detention of B.N. The Hospital alleged that B.N.

was suffering from a psychiatric disorder and was both gravely disabled and

dangerous to himself and others. The application indicated that B.N. had been

“agitated, delusional, paranoid, not sleeping, report[ing] God is speaking to

him[,]” had been “refusing medication” and had “poor insight and poor

judgment[.]” (App. Vol. 2 at 10, 11). The application also indicated that B.N.

had suicidal ideation. [4] A few days later, Dr. Hasan filed a Report Following Emergency Detention,

requesting the trial court to order B.N. to be involuntary committed to the

Hospital on a temporary basis. Dr. Hasan indicated that B.N. was suffering

from a delusional disorder and schizophrenia and that he was dangerous and

gravely disabled. More specifically, Dr. Hasan reported that B.N. had poor

insight, did not believe that he had a mental illness, and had been refusing

treatment.

Court of Appeals of Indiana | Opinion 19A-MH-1037 | December 20, 2019 Page 3 of 15 [5] On April 9, 2019, the trial court held a commitment hearing. In support of its

involuntary temporary commitment request, the Hospital presented testimony

from Dr. Hasan; B.N. stipulated that the doctor was an expert in psychiatry.

Dr. Hasan testified that he had examined B.N. four times during his hospital

admission, including on the day of the hearing, and he had diagnosed B.N.

with delusional disorder and schizoaffective disorder, bipolar type. The doctor

also testified that B.N. had a history of mental illness and that he had had a

prior hospitalization in Ohio and had received treatment at Gallahue. Dr.

Hasan testified that, at the time of B.N.’s emergency admission, B.N. “had been

increasingly paranoid and [had been] exhibiting erratic and dangerous

behavior.” (Tr. Vol. 2 at 6). Additionally, B.N. had not been sleeping or eating

and had not been receiving treatment. However, B.N. did report to Dr. Hasan

that he had been in the process of getting established at the VA hospital for

psychiatric treatment. [6] Dr. Hasan testified that B.N. did not have insight into his illness when he was

not taking medication and that, based on B.N.’s history, there was a risk that

B.N. was dangerous to others. According to Dr. Hasan, B.N. had been “very

religiously preoccupied[,]” believing that God was speaking to him, “thinking

that he [wa]s doing the work of God – missionary work[,]” and “need[ing] to

get churches.” (Tr. Vol. 2 at 7). On one occasion, which was at the time of “the

New Zealand shooting incident in the mosque[,]” B.N. had “parked a car in

front of [a] church so people could not come out of the front door[,]” and the

police were called to the scene. (Tr. Vol. 2 at 8). According to Dr. Hasan, B.N.

Court of Appeals of Indiana | Opinion 19A-MH-1037 | December 20, 2019 Page 4 of 15

had had “several instances where he ha[d] been involved with the police

department filing complaints[,] and [he] then believe[d] that there [wa]s a

conspiracy going on against him.” (Tr. Vol. 2 at 7). Dr. Hasan testified that, in

addition to B.N.’s “encounters with the police department” and the “incident at

the church[,]” he was also concerned about B.N.’s “hyper focus on people in

higher positions abusing power and then acting in a way that c[ould] be

dangerous.” (Tr. Vol. 2 at 11). In 2015, B.N. had complained about the mayor

and the abuse of power, and he sent the mayor emails that were “perceived

maybe as an indirect threat.” (Tr. Vol. 2 at 11). Dr. Hasan further testified

that, during B.N.’s hospitalization, he had been “very paranoid with the staff

members[,]” thinking that they had “a conspiracy against him[.]” (Tr. Vol. 2 at

9). Additionally, B.N. had not followed directions from the staff and had

become “extremely agitated” to the point where he had hit a nurse. (Tr. Vol. 2

at 9). [7] Dr. Hasan also testified that B.N. was gravely disabled and had an “impaired

ability to function independently.” (Tr. Vol. 2 at 9). The doctor explained that

B.N. had been “disorganized and erratic and dangerous” when he was first

admitted and that he had been unable to work because he had been “doing

work for God[.]” (Tr. Vol. 2 at 9). Dr. Hasan testified that when B.N. became

paranoid and delusional, his ability to follow directions and to trust people

became compromised. [8] Dr. Hasan further testified that his treatment plan for B.N. included continued

in-patient treatment, two injections of an anti-psychotic medication, and then a

Court of Appeals of Indiana | Opinion 19A-MH-1037 | December 20, 2019 Page 5 of 15

transition to outpatient services within one week. The doctor also testified that

B.N. had initially indicated that he would refuse to take any medications

without a court order but that he then had begun to take the medication, which

had yielded “some improvement[.]” (Tr. Vol. 2 at 12). Dr. Hasan explained

that an involuntary temporary commitment was recommended to improve

B.N.’s condition and to stabilize his medication before moving him to

outpatient treatment. According to Dr. Hasan, the prescribed medications and

treatment plan would help to treat B.N.’s mental illness. He also testified that,

with treatment, B.N.’s prognosis was “fair” and that, without treatment, his

prognosis was “poor.” (Tr. Vol. 2 at 13). Additionally, Dr. Hasan testified that

he had talked to B.N. about the Hospital’s petition seeking the temporary

commitment and that B.N. “was in agreement for this temporary commitment

and even the injection[.]” (Tr. Vol. 2 at 11). [9] Following Dr. Hasan’s testimony, B.N. testified and corroborated Dr. Hasan’s

testimony that he had agreed that he would follow the doctor’s

recommendations for further commitment and medication. B.N.’s counsel

questioned B.N. as follows:

[B.N.’s Counsel:] Okay. And you know why we are here today, correct?

[B.N.:] Yes, ma’am.

[B.N.’s Counsel:] Okay. And the doctor testified that you guys spoke this morning and you wished to stay on your commitment. Is that true?

Court of Appeals of Indiana | Opinion 19A-MH-1037 | December 20, 2019 Page 6 of 15

[B.N.:] I am willing to comply with what the doctor recommends.

[B.N.’s Counsel:] Okay. And has anyone forced you to say that or is this on your own?

[B.N.:] I have wanted counseling prior to this and I have got an appointment scheduled with the VA Hospital next Monday. My only concern is the forced medication of the anti-psychotic medicine. I have had bad experiences with these in the past. But I am willing to comply with the doctor at this time – with the required medication.

[B.N.’s Counsel:] Okay, do you understand your diagnosis?

[B.N.:] Actually, I have a little disagreement regarding paranoia. From what I am understanding, paranoia is an unreasonable fear and I fear only displeasing God.

[B.N.’s Counsel:] Is there anything else you would like the court to know?

[B.N.:] Yes, ma’am.

[B.N.’s Counsel:] Okay.

[B.N.:] I get social security disability of about nine hundred and fifty dollars a month. Which with my pledge of poverty as a Quaker father, this gives me all the funds and supplies all the needs that I have at this time. Regarding the assault – regarding a woman being kicked – I did not intentionally do that. If I did, I have not seen any evidence regarding a bruise on her foot. It is not my intention to hurt or harm anybody at any time. So if she was hurt by me, it was totally by accident and I apologize. I would like to also explain my initial refusal of medications. I have had bad luck with anti-psychotics in the past so I was willing to take all the medications except for the anti-psychotic up until Saturday. Once I realized that I was able to handle the medications without any adverse reactions, I agreed to go ahead Court of Appeals of Indiana | Opinion 19A-MH-1037 | December 20, 2019 Page 7 of 15

and take the anti-psychotic last Saturday. So I have been complying with the required medications ever since. My phone is a lifeline phone and it is free to me. But incoming calls – I do not answer. They go directly to voicemail. Text is the best way to contact me and I will call you back on my phone. That is how I have been handling it.

(Tr. Vol. 2 at 15-16). [10] After B.N. had finished testifying, the trial court posed the following question to

B.N.:

Alright. [B.N.], can I just clarify for purposes of the record? What the hospital is requesting is that the court place you on a temporary commitment which means that you would be under court order to take whatever medications Dr. Hasan prescribes as well as to attend your clinic sessions and follow up with your treat[ment] – are you – just so that I am clear – are you in agreement with that at this point in time?

(Tr. Vol. 2 at 16). B.N. responded, “I have no objection to that, your honor.”

(Tr. Vol. 2 at 16). The trial court then asked the parties’ attorneys whether they

would “waive argument in that case[,]” and both attorneys agreed. (Tr. Vol. 2

at 16). [11] Thereafter, the trial court granted the hospital’s petition for an involuntary

temporary commitment and stated:

Thank you. Alright. So based on the evidence and [B.N.’s] testimony, the court does find by clear and convincing evidence that he suffers from mental illness, specifically Schizoaffective Disorder Bipolar Type. The court further finds that [B.N.] is gravely disabled in that he is demonstrating an obvious

Court of Appeals of Indiana | Opinion 19A-MH-1037 | December 20, 2019 Page 8 of 15

deterioration in his judgement, reasoning and behavior that has resulted in his inability to function independently at this point in time. And the court bas[e]s that on the doctor’s testimony regarding his behavior on the unit and the doctor’s assessment that he would be unable to sustain a job at this point in time due to his disorganized thoughts, erratic behavior, lack of insight and religious preoccupation. The court further finds that [B.N.] is a danger to others and that is based on the testimony concerning assault on a nurse both from the doctor and from [B.N.]. Although, the court recognizes that [B.N.] indicates that was an accident. Based on all of the testimony including [B.N.’s] lack of objection to the court, grants the order of temporary commitment. . . .

(Tr. Vol. 2 at 16-17). The trial court’s written temporary commitment order

indicated that the commitment was based “[u]pon evidence presented” and that

the trial court had found “by clear and convincing evidence” that B.N. was

suffering from a mental illness (delusional disorder and schizoaffective disorder,

bipolar type) and that he was both dangerous to others and gravely disabled.

The trial court also found that B.N. was in need of the custody, care, and

treatment at the Hospital for a period not to exceed ninety days (up until July 8,

2019 unless discharged prior to that date). B.N. now appeals.

Decision [12] B.N. challenges the trial court’s order for his involuntary temporary

commitment to the Hospital for a period not to exceed ninety days. We

initially note, however, that the trial court ordered B.N. to be committed up to

July 8, 2019 unless discharged earlier. Because B.N. has already been

discharged from the Hospital, this matter is moot. See In re Commitment of J.M.,

Court of Appeals of Indiana | Opinion 19A-MH-1037 | December 20, 2019 Page 9 of 15

62 N.E.3d 1208, 1211 (Ind. Ct. App. 2016). “When a court is unable to render

effective relief to a party, the case is deemed moot and usually dismissed.” Id.

(internal quotation marks and citations omitted). We, however, may decide

such cases where they involve questions of great public interest that are likely to

recur. Id. The question of how persons subject to involuntary commitment are

treated by our trial courts is one of great importance to society. Id. We will

therefore address B.N.’s argument. [13] To obtain an involuntary commitment, 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.” IND. CODE § 12-26-2-5(e) (format altered). Thus,

here, the Hospital had the burden of proving subsections (1) and (2) by clear

and convincing evidence. [14] B.N. does not dispute the sufficiency of evidence supporting the elements that

he is mentally ill and either dangerous or gravely disabled under INDIANA

CODE § 12-26-2-5(e)(1). Instead, he ultimately challenges the evidence

supporting INDIANA CODE § 12-26-2-5(e)(2), arguing that the Hospital did not

prove by clear and convincing evidence that the commitment was appropriate. [15] B.N.’s main appellate challenge, however, is a due process argument, in which

he contends that the trial court violated his due process right of having the

Hospital meet its burden of proving the involuntary commitment elements by

clear and convincing evidence. Specifically, he maintains that the trial court

Court of Appeals of Indiana | Opinion 19A-MH-1037 | December 20, 2019 Page 10 of 15

violated this due process right when it ordered him to an involuntary temporary

commitment based in part on his own testimony given during the commitment

hearing. He asserts that the trial court’s consideration of his testimony, in

which he corroborated Dr. Hasan’s testimony that he had agreed to follow the

doctor’s recommendations, reduced the Hospital’s burden of proving the

involuntary commitment elements and resulted in a violation of his due process

right. [16] The purpose of civil commitment proceedings is to protect the public and to

ensure the rights of the person whose liberty is at stake. Civil Commitment of

T.K. v. Dep’t of Veterans Affairs, 27 N.E.3d 271, 273 (Ind. 2015). Given the

liberty interest at stake, the serious stigma involved, and the adverse social

consequences that accompany such physical confinement, a proceeding for an

involuntary civil commitment is subject to due process requirements. Id. In

order to protect the due process rights of a person subject to commitment, the

facts justifying an involuntary commitment must be shown by clear and

convincing evidence. Id. This standard of proof “communicates the relative

importance our legal system attaches to a decision ordering an involuntary

commitment,” and it has the function of reducing the likelihood of

inappropriate commitments. Id. (internal quotation marks and citation

omitted). When we review the sufficiency of the evidence supporting an

involuntary civil commitment, we will affirm if, after considering the probative

evidence and reasonable inferences supporting the decision, a reasonable trier of

fact could have found the necessary elements proven by clear and convincing

Court of Appeals of Indiana | Opinion 19A-MH-1037 | December 20, 2019 Page 11 of 15

evidence. Id. We do not reweigh the evidence, nor do we judge witness

credibility. Id. [17] Here, during the commitment hearing, the Hospital set forth to meet its burden

of proving the involuntary commitment elements through the testimony of Dr.

Hasan, whom B.N. stipulated was an expert in psychiatry. Dr. Hasan gave

detailed testimony regarding: (1) what had precipitated B.N.’s emergency

commitment; (2) B.N.’s mental illness diagnosis; (3) how B.N. posed a danger

to others, including his past actions at the church and the injury caused to a

nurse during his emergency commitment; (4) how B.N.’s judgment had been

impaired by his disorganized thoughts, erratic behavior, lack of insight, and

religious preoccupation; (5) the doctor’s proposed treatment plan, which

included two injections of an anti-psychotic medication, some other

medications, and a transition to outpatient services within one week; (6) how

B.N. had initially refused to take medication without a court order but then had

recently taken some medication that had yielded some improvement; (7) B.N.’s

prognosis with and without further treatment; and (8) the need for B.N.’s

temporary commitment at the Hospital in order to improve B.N.’s condition

and to stabilize his medication before moving him to outpatient treatment. At

the end of his testimony, Dr. Hasan indicated that he had talked to B.N. about

the temporary commitment petition and treatment plan and that B.N. “was in

agreement for this temporary commitment and even the injection[.]” (Tr. Vol.

2 at 11). Thereafter, B.N. testified and corroborated Dr. Hasan’s testimony that

he had agreed that he would follow the doctor’s recommendations for further

Court of Appeals of Indiana | Opinion 19A-MH-1037 | December 20, 2019 Page 12 of 15

commitment and medication. The trial court then questioned B.N. to clarify

his testimony, and B.N. confirmed that he had “no objection[.]” (Tr. Vol. 2 at

16). The trial court then, “based on the evidence and [B.N.’s] testimony,”

found “by clear and convincing evidence” that B.N. should be ordered to a

temporary commitment. (Tr. Vol. 2 at 16-17). [18] We reject B.N.’s argument that the trial court’s consideration of his testimony

and question about his agreement with Dr. Hasan’s recommendations

essentially equated to a reduction of the Hospital’s burden of proving the

temporary commitment elements by clear and convincing evidence. B.N.’s

argument seems to suggest that the trial court was not allowed to consider his

testimony when determining whether there was clear and clear and convincing

evidence to support the temporary commitment order. However, B.N.’s

testimony, along with the testimony of Dr. Hasan, was evidence. Moreover,

our review of the record on appeal reveals that there was no such burden

reduction. Indeed, the trial court specified, both at the commitment hearing

and in its commitment order, that it had found that the elements of the

temporary commitment were supported by clear and convincing evidence.

There is no evidence that the trial court either explicitly or implicitly held the

Hospital to a lesser burden of proof. As a result, the trial court did not violate

B.N.’s due process right.2

2 We also reject B.N.’s convoluted argument that the trial court’s consideration of and reliance upon his testimony resulted in the trial court conflating the involuntary and voluntary commitment statutes and

Court of Appeals of Indiana | Opinion 19A-MH-1037 | December 20, 2019 Page 13 of 15 [19] Lastly, we address B.N.’s sufficiency challenge to the evidence supporting the

involuntary commitment element, under INDIANA CODE § 12-26-2-5(e)(2), that

the commitment was appropriate. B.N. raised the challenge to this element

under a harmless error analysis to his due process argument. Because there was

no due process violation, we will not review his argument under harmless error.

Instead, we will treat it as a sufficiency argument. [20] B.N. contends that the Hospital presented “minimal evidence” of the element

that the commitment was appropriate and that his own testimony, which he

suggests should not have been considered by the trial court, was the “primary

evidence” of the element. (B.N.’s Br. 19, 20). We disagree. [21] As discussed above, Dr. Hasan testified about B.N.’s mental illness diagnosis,

how B.N. posed a danger to others, and how B.N.’s judgment had been

impaired by his disorganized thoughts, erratic behavior, lack of insight, and

religious preoccupation. The doctor also discussed B.N.’s proposed treatment

plan, which included two injections of an anti-psychotic medication and a

transition to outpatient services within one week. Dr. Hasan further testified

about B.N.’s prognosis with and without further treatment and the need for

B.N.’s temporary commitment at the Hospital in order to improve B.N.’s

condition and to stabilize his medication before moving him to outpatient

turning this involuntary commitment proceeding into a voluntary one. Our review of the record reveals that this was an involuntary commitment proceeding in which B.N. chose to testify and corroborated Dr. Hasan’s testimony that he was willing to follow the doctor’s treatment and medication recommendations.

Court of Appeals of Indiana | Opinion 19A-MH-1037 | December 20, 2019 Page 14 of 15

treatment. B.N.’s argument is nothing more than a request to reweigh the

evidence, which we will not do. T.K., 27 N.E.3d 273. We affirm the trial

court’s involuntary temporary commitment order. [22] Robb, J., and Mathias, J., concur.

Court of Appeals of Indiana | Opinion 19A-MH-1037 | December 20, 2019 Page 15 of 15