J.S. v. Center for Behavioral Health

• Decision Date: 12 May 2006
• Docket Number: No. 53A04-0509-CV-563.,53A04-0509-CV-563.
• Citation: 846 N.E.2d 1106
• Parties: J.S., Appellant, v. CENTER FOR BEHAVIORAL HEALTH, Appellee.
• Court: Indiana Appellate Court

846 N.E.2d 1106

J.S., Appellant, v. CENTER FOR BEHAVIORAL HEALTH, Appellee.

No. 53A04-0509-CV-563.

Court of Appeals of Indiana.

May 12, 2006.

COPYRIGHT MATERIAL OMITTED

Michael L. Jenuwine, South Bend, for Appellant.

OPINION

SHARPNACK, Judge.

J.S. appeals the trial court's grant of a commitment and forced medication order sought by the Center for Behavioral Health ("CBH").¹ J.S. raises two issues, which we restate as:

I. Whether the evidence is sufficient to sustain the trial court's commitment order; and

II. Whether evidence is sufficient to sustain the trial court's forced medication order.

We affirm.

The relevant facts follow. J.S. is a forty-eight-year-old woman who has been diagnosed with a "psychotic disorder, not otherwise specified" with "many of the typical symptoms of schizophrenia, the paranoid type, but the diagnosis is complicated by the fact that she [has] a persistent uncontrolled epileptic disorder." Transcript at 71. As a teenager, J.S. was diagnosed with the seizure disorder that has required significant medical intervention. She was hospitalized as a result of her mental illness for the first time when she was sixteen years old and has been hospitalized at least four additional times. Approximately ten years ago, J.S. underwent surgery to remove a significant portion of her left temporal lobe in an effort to control her seizures. Additionally, J.S. had a vagus nerve stimulator implanted on February 23, 1998, which has improved her seizure control. However, "these types of epileptic formed seizures can produce psychotic symptoms on their own at times," and the surgery cannot "be completely excluded in the formation of the psychotic symptoms which she experiences." Id. J.S.'s seizure disorder is treated by a neurologist, Dr. Flint, and she receives mental health treatment from Dr. Jerry Neff at the CBH.

In 2001, J.S. was involuntarily committed after she refused to take her medicine because she believed that it had been poisoned and after she refused to eat and lost a significant amount of weight. Her mother was appointed as guardian in 2003. However, J.S.'s mother has deferred many of her responsibilities to the CBH.

In late 2003 and early 2004, J.S. again refused to eat because she thought that her food was being poisoned, and her CBH case manager found bottles of oral Risperdal that J.S. had not taken. Risperdal is a medication used to treat schizophrenia. In December 2003, J.S. became verbally aggressive with her case manager, would not let the case manager leave J.S.'s house, and "came within inches of [the case manager's] face and screamed and was threatening and verbally aggressive." Id. at 14-15. On January 15, 2004, CBH filed an application for an emergency detention, which was granted.

On January 20, 2004, CBH filed a petition for a regular involuntary commitment, and a hearing was held on January 28, 2004. The trial court granted the petition for a regular involuntary commitment and found that J.S. was "suffering from severe seizure disorder/chronic paranoid schizophrenia, mental illness as defined in I.C. 12-7-2-130(1)," and that J.S. was "a danger is [sic] gravely disabled as defined in I.C. 12-7-2-96 and is in need of continuing care or treatment." Appellant's Appendix at 11. The trial court also found that J.S.'s "condition will deteriorate if she does not receive medication regularly and the benefits of the medication outweigh the possible side effects." Id. The trial court ordered that J.S. be committed to the Bloomington Hospital Med Psych Unit and ordered the hospital to administer medication to J.S. with or without her consent. Id.

J.S. started receiving injectable Risperdal Consta on January 15, 2004, to help control her symptoms of schizophrenia. J.S.'s mother, her guardian, was in favor of the recommitment. J.S.'s mother contacted Dr. Flint regarding the Risperdal injections, and he did not raise any objections to the medication.

At some point, J.S. was released from the hospital to her own apartment but was required to return to CBH every other week for a Risperdal Consta injection and meet with her CBH case manager weekly. Her dosage of Risperdal Consta was increased on May 17, 2004. Dr. Flint informed CBH on June 7, 2004, that J.S.'s seizure activity was well controlled and that the Risperdal had not made any differences in J.S.'s seizure activity.

The Risperdal Consta improved J.S.'s mental health. In fact, according to her mother, J.S. improved dramatically and was "managing her life real well." Transcript at 123. However, J.S. does not believe that she is mentally ill and does not want to take antipsychotic drugs. During this time, J.S. was living in an apartment with her boyfriend, cleaned the apartment, cooked meals, refilled her prescriptions, scheduled her own doctor appointments, and arranged for transportation.

Between October 1, 2004 to January 28, 2005, J.S. did not receive her Risperdal Consta injections because, according to J.S., the CBH "was always closed" when she went there. Id. at 149. J.S. started receiving the injections again on January 28, 2005, when her case manager realized that J.S. had not been getting the injections.

On December 14, 2004, the CBH filed a request to continue J.S.'s regular commitment without a hearing and a periodic report regarding J.S. pursuant to Ind. Code § 12-26-15-1. The periodic report provided that J.S. "lacks judgment into taking her medication appropriately. She lacks insight into her mental illness and does not seem to be accepting of it. [J.S.] has become extremely reluctant to being medication compliant." Appellant's Appendix at 14. The periodic report also alleged: "[J.S.] suffers from a psychiatric disorder which causes her to be reluctant to taking the medication that will control it. When [J.S.] does not take her medication, she decompensates very quickly, has a history of injuring herself, becomes paranoid and sometimes violent." Id.

The trial court granted CBH's request and ordered that CBH provide another periodic report not later than January 28, 2006. At J.S.'s request, the trial court held a hearing on the matter. After the hearing, the trial court entered findings of fact and conclusions thereon as follows:

* * * * *

7. Jerry Neff, M.D., psychiatrist on the staff of [CBH], testified that:

a. the [CBH's] services in this case were in accordance with professional practices and appropriate for [J.S.'s] needs.

b. [J.S.] has a history of psychiatric issues since age 17.

c. [J.S.] is suffering from a mental illness which disturbs her thinking, her behavior, her feelings, and will impair her ability to function in the absence of medication.

d. When [J.S.] fails or refuses to take her medication, she distrusts her family, believes her family is mentally ill, and believes she is the only rational person.

e. [J.S.] has a history of anger.

f. [J.S.] has reported she was a government test subject and had a device implanted in her head.

g. [J.S.] has reported being a government spy; believed people were trying to kill her; and reported leading politicians consulted her on a variety of subjects.

h. [J.S.] had been non-compliant in taking her medication, Risperdal, prior to the filing of the Request to Continue the Regular Commitment and Forced Medication Order.

i. [J.S.'s] failure to comply with the medication order will result in her eventual decomposition and a return to the hospital as occurred in December 2003 — January 2004, and three times prior to that.

j. [J.S.] has persistent, uncontrolled seizures.

k. [J.S.'s] guardian and her neurologist were both consulted prior to the Risperdal order and agreed with it.

l. He had formed an opinion, prior to the Risperdal order, that this medication would be of substantial benefit in treating [J.S.'s] condition by lowering the intensity of her paranoia, and he continues to so believe based on the effects of the medication on [J.S.].

m. It is possible, explaining how, for an individual, such as [J.S.], to fail to take her medication for a period of time, such as here, and not evidence any negative effects from being non-compliant, during the time she was non-compliant.

n. He believes any possible side effects or risk of harm, and [J.S.'s] personal concerns, are outweighed by the possible benefits of this medication.

o. He has not seen nor has he been advised of any adverse effects of this medication to [J.S.] other than by [J.S.] herself.

p. He has not been advised by any professional involved with [J.S.'s] care that this medication has caused an increase in [J.S.'s] seizures; nor has he been advised by [J.S.'s] neurologist to discontinue or modify the Risperdal injections.

q. He has considered alternative forms of treatment and medications and believes Risperdal is the best and least restrictive medication for [J.S.'s] condition at this time.

r. He is of the opinion that, as in the past, [J.S.] will become gravely disabled and/or dangerous to herself or others if she is allowed to refuse her medication and subsequently decompensates, which will, in fact, occur.

8. Prior to commitment, [J.S.] at one time lost 10 to 20 pounds because she stopped eating, fearing that her food was poisoned; washed her hands repeatedly until they were dry, red and cracked; exhibited limited insights into her finances; blocked the door of her apartment, not allowing her Case Manager to leave; and became involved in a physical altercation with neighbors and made verbal threats to treatment staff and her family.

9. [J.S.'s] mother testified that she agrees that the Regular Commitment and Forced Medication Order should be continued as [J.S.'s] psychosis has improve dramatically since the medication was ordered.

10. No evidence, except for [J.S.'s] testimony, was presented to contradict Dr. Neff's testimony that [J.S.] is mentally ill and will become gravely disabled and/or dangerous to herself or others if allowed to discontinue her medication.

11....