Civil Commitment of W.S. v. Eskenazi Health, Medtown Cmty. Mental Health
| Decision Date | 16 December 2014 |
| Docket Number | No. 49A02–1404–MH–274.,49A02–1404–MH–274. |
| Citation | 23 N.E.3d 29 |
| Parties | In the Matter of the CIVIL COMMITMENT OF W.S., Appellant–Respondent, v. ESKENAZI HEALTH, MIDTOWN COMMUNITY MENTAL HEALTH, Appellee–Petitioner. |
| Court | Indiana Appellate Court |
Deborah Markisohn, Marion County Public Defender, Appellate Division, Indianapolis, IN, Attorney for Appellant.
Jarrell B. Hammond, Lewis Wagner, LLP, Indianapolis, IN, Attorney for Appellees.
CRONE
, Judge.
W.S. appeals the trial court's order on review of his regular mental health commitment. W.S. has been involuntarily committed to Eskenazi Health, Midtown Community Mental Health (“Midtown”) pursuant to a regular commitment since March 2009. Following a hearing upon W.S.'s petition for review, the trial court determined that W.S. is mentally ill and gravely disabled and should remain under a regular commitment at Midtown for a period of time expected to exceed ninety days. The court's order provided, as a condition of the regular commitment, that W.S. take all medication as prescribed. W.S. argues that the trial court's order is not supported by clear and convincing evidence. Finding clear and convincing evidence that W.S. is mentally ill and gravely disabled but that the trial court should hear additional evidence regarding the portion of the order regarding medication, we affirm and remand for further hearing.
Forty-three-year-old W.S. suffers from paranoid schizophrenia
. W.S.'s involvement with the civil commitment process began as early as 1994 when an application for emergency detention was filed and resulted in him being temporarily committed. That temporary commitment expired in August 1994, and it appears that W.S. was not subject to any commitment for the next four years. However, in April 1998, W.S. was placed on regular commitment for a period of four years until the commitment was terminated in September 2002. Thereafter, in May 2008, an application for emergency detention was filed, but the subsequent petition for W.S.'s involuntary commitment was denied by the trial court. In September 2008, another application for emergency detention was filed, and again the subsequent petition for W.S.'s involuntary commitment was denied by the trial court.
Applications for emergency detention were filed in January and February 2009, and a petition for involuntary commitment was filed on March 2, 2009. Following a hearing, W.S. was ordered involuntarily committed under a regular commitment to Midtown. From February 2010 to December 2013, the trial court periodically reviewed the facts supporting W.S.'s regular commitment based upon written reports and evidence heard during review hearings and each time ordered that his commitment be continued. Pursuant to his regular commitment, W.S. lives independently but must attend scheduled appointments at Midtown and receive monthly medication injections.
On February 12, 2014, W.S. filed a petition for review of his regular commitment. A review hearing was held on March 25, 2014. During the hearing, Midtown medical director and chief of psychiatrist services, Dr. Jeffrey Kellams, testified that W.S. has been a patient of Midtown going on thirty years. Dr. Kellams stated that W.S. was first diagnosed with paranoid schizophrenia
in the “early 1980s” and Dr. Kellams has been actively involved in his treatment over the last three or four years. Tr. at 6. Based upon a recent medical examination of W.S., Dr. Kellams concluded the following:
[W.S.] suffers a chronic psychotic illness, paranoid schizophrenia
, which has been present for at least three decades, if not longer. It has resulted in his having very poor insight, poor judgment. With medication, he actually does reasonably well. Without medication, he goes into a state of denial, feeling that he does not need to see the psychiatrist, does not need to seek medication; becomes delusional, paranoid, and on multiple occasions has come to the attention of the public or police because of deviant behavior.... [T]he reality of it is if we do not continue the commitment, he very likely will quit coming for appointments. He does not see that he needs ongoing care, and the subsequent result of that would be lack of medication and a deterioration into a chronic psychotic state which will bring him to the attention of family, police, neighbors, whatever, once again.
Id. at 7–9. Dr. Kellams acknowledged that W.S. is “being forced to take medication against his will pursuant to the commitment order” but that the commitment order was absolutely necessary and in W.S.'s best interests because W.S. would not otherwise voluntarily come in and take his medication. Id. at 13.
Midtown clinical nurse specialist Christopher Miller testified that he provides care to W.S. frequently and that W.S. suffers from ongoing paranoia that “would definitely get worse” if not medicated. Id. at 17. Nurse Miller stated that W.S. is favorably responding to the prescribed Haldol
Decanoate injections and that W.S. would definitely fail to “show up” to take his medication if he were not under a commitment order. Id. at 17.
W.S. also testified at the hearing. He stated that if the commitment order was discontinued, “I honestly think I'd do okay.” Id. at 19. W.S. testified that he does not believe that he suffers from any mental illness and that he would not voluntarily receive medication injections if not court-ordered to do so. W.S. stated that the injections are painful and make him feel violated, but that there is a “possibility” that he would voluntarily take an oral medication. Id. at 22.
Following the hearing, the trial court concluded that W.S. suffers from a mental illness and is gravely disabled, and therefore W.S.'s regular commitment and court-ordered medication should continue. This appeal ensued.1
W.S.'s sole assertion on appeal is that the trial court's order continuing his regular commitment and the condition that he continue to take medication as prescribed are not supported by clear and convincing evidence.2 Our well-settled standard of review and our relevant statutory law regarding civil commitment are as follows:
. In order to carry its burden of proof, the petitioner is not required to prove that the individual is both dangerous and gravely disabled. However, there is no constitutional basis for confining a mentally ill person who is not dangerous and can live safely in freedom.
M.L. v. Meridian Servs., Inc., 956 N.E.2d 752, 755 (Ind.Ct.App.2011)
(quotation marks and some citations omitted).
Section 1—Gravely Disabled
We initially note that W.S. does not challenge the trial court's finding that he suffers from mental illness pursuant to Indiana Code Section 12–7–2–130
, which 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. Instead, W.S. contends that Midtown failed to present sufficient evidence to support the trial court's finding that he is gravely disabled.
(emphasis added). As we have often noted, because this statute is written in the disjunctive, a trial court's finding of grave disability survives if we find that there was sufficient evidence to prove either that the individual is unable to provide for his basic needs or that his judgment, reasoning, or behavior is so impaired or deteriorated that it results in his inability to function independently. See
T.A. v. Wishard Health Servs., 950 N.E.2d 1266, 1271 n. 2 (Ind.Ct.App.2011) ; A.L. v. Wishard Health Servs., 934 N.E.2d 755, 762 n. 2 (Ind.Ct.App.2010), trans. denied (2011).
The evidence most favorable to the trial court's determination that W.S. is gravely disabled indicates that he suffers from paranoid schizophrenia
and has been the subject of numerous prior mental health commitments. Dr. Kellams testified that without medication and treatment, W.S. becomes delusional and paranoid and has come to the attention of the public and the police on multiple occasions after engaging in deviant and criminal behavior. Dr. Kellams testified that the regular commitment remains necessary to prevent W.S. from deteriorating into a chronic psychotic state. The record indicates that W.S.'s condition has somewhat stabilized with medication injections, but that he requires ongoing treatment to maintain this stabilized condition. Dr. Kellams stated that W.S. continues to lack insight into his mental illness. Indeed, W.S. testified that he does not believe that he suffers from mental illness and...
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