Mental Commitment of M.P., In re

• Court: Indiana Appellate Court
• Writing for the Court: CONOVER; BUCHANAN; SULLIVAN; SULLIVAN
• Citation: Mental Commitment of M.P., In re, 500 N.E.2d 216 (Ind. App. 1986)
• Decision Date: 18 November 1986
• Docket Number: No. 2-1185A355,2-1185A355
• Parties: In re the MENTAL COMMITMENT OF M.P.

Page 216

500 N.E.2d 216

In re the MENTAL COMMITMENT OF M.P.

No. 2-1185A355.

Court of Appeals of Indiana Second District.

Nov. 18, 1986.

Rehearing Denied Dec. 22, 1986.

Kenneth J. Falk, Diana Mitchell, Legal Services Organization of Indiana, Inc., Indianapolis, for appellant.

Linley E. Pearson, Atty. Gen., Robert S. Spear, Chief Counsel, Office of Atty. Gen., Indianapolis, for appellee.

CONOVER, Presiding Judge (Sitting by Designation).

M.P. appeals the Marion Municipal Court, Room No. 3's order continuing his regular commitment to Central State Hospital and allowing the State to forcibly medicate him with antipsychotic medications.

We affirm.

ISSUES

This appeal presents the following issues:

1. whether the trial court's finding M.P. is mentally ill and gravely disabled is supported by clear and convincing evidence, and

2. whether the court erred by determining M.P. could be forcibly medicated with antipsychotic medications having the possibility of serious side effects because the evidence did not show M.P. was immediately dangerous to himself and others.

FACTS

M.P. is a 28-year-old male with a history of hospitalizations and treatment for mental illness for more than two years. Currently, he is involuntarily confined to Central State Hospital. He was admitted in March, 1984, then put on out-patient status, but has been an in-patient continuously since August, 1984. He has never been adjudicated an incompetent.

In the recent past, M.P. has had severe delusions and has attempted suicide. Currently, his psychiatrist at Central State Hospital, Dr. Stoner, diagnoses M.P.'s problem as chronic undifferentiated schizophrenia: "Right now it is not as bad as it could be; but it's not perfect either, not well enough to leave the hospital." M.P. is not currently dangerous. He is unable to meet his basic needs, has no income, is not employable, and has no suitable plans in the event of his release. If released, he plans to go to the Salvation Army because he has no other place to stay, and to live on food stamps until he can get a job.

On one occasion while off his medication, M.P. grabbed another patient by the throat. Another time he was found with a butter knife in his possession.

Prior to his annual review hearing, M.P. began to refuse his medications after consulting a lawyer. Afterwards, his mental condition began to deteriorate. When he did cooperate and take his medicine, his condition improved, and he was able to think more clearly. If he would cooperate and continue taking his medication he could eventually leave the hospital as has been the case in the past, his psychiatrist believes.

Further facts as necessary appear below.

DISCUSSION AND DECISION

M.P. first attempts to challenge both the sufficiency of the evidence to sustain the trial court's findings of fact and the sufficiency of the findings to sustain the judgment, then the admissibility of his relatives' testimony concerning his aberrant behavior prior to his hospitalization. These issues are waived. ¹

1. "Clear and Convincing" Evidence Standard.

A. Standard in Trial Courts.

To satisfy federal due process requirements the State must prove the defendant's mental condition requires him to be hospitalized and treated for the protection of himself and the public by "clear and convincing" evidence. Addington v. Texas (1979), 441 U.S. 418, 432-433, 99 S.Ct. 1804 1812-1813, 60 L.Ed.2d 323. However, the Addington court left it to the states to determine whether a greater evidentiary burden should be imposed upon the state, acting in its capacity as parens patriae, before enforced hospitalization could be ordered.

Our Supreme Court recently discussed the clear and convincing evidence standard. In Orkin Exterminating Co. v. Traina (1986), Ind., 486 N.E.2d 1019, a punitive damages case, Justice Prentice, speaking for a unanimous court [Shepard, J. not participating] said

In Travelers Indemnity Co. v. Armstrong, [ (1982) Ind., 442 N.E.2d 349] supra, we established the "clear and convincing evidence" standard ... a standard which is but minutely below the "reasonable doubt" standard, because such actions are more akin to criminal actions than to civil suits,.... The rule is nothing more than the rule applicable in criminal trials resting entirely upon circumstantial evidence, i.e. the evidence must exclude every reasonable hypothesis of innocence. (Emphasis supplied).

Traina, 486 N.E.2d 1022, 1023. Accord, Manlove v. State (1968), 250 Ind. 70, 77, 232 N.E.2d 874, 878. A conviction may be based solely on circumstantial evidence. Correll v. State (1985), Ind., 486 N.E.2d 497, 500; Watkins v. State (1984), Ind., 468 N.E.2d 1049, 1052. Thus, trial courts must apply "the exclusion of every reasonable hypothesis of innocence" test to the evidence before them in favor of the defendant when considering whether an allegedly mentally ill person may be hospitalized against his will under the rule in Traina.

B. Standard of Review on Appeal.

On appeal, the reviewing court examines the record to determine whether there was substantial evidence to support the trial court's findings on each of the issuable facts or elements the State must prove in such cases beyond a reasonable doubt. Marshall v. State (1982), Ind., 438 N.E.2d 986, 987. When sufficiency of the evidence is at issue, we look only to the evidence most favorable to the State and all reasonable inferences to be drawn therefrom. If substantial evidence establishes each necessary element of the matter beyond a reasonable doubt, the trial court's verdict or judgment will not be disturbed. The reviewing court will not weigh conflicting evidence nor judge the credibility of witnesses. Loyd v. State (1980), 272 Ind. 404, 398 N.E.2d 1260, 1264. Accord, Smith v. State (1984), Ind., 468 N.E.2d 512 515; Marshall, 438 N.E.2d at 987. Finally, the Traina court instructs

Whatever standard of proof is required at the trial level, if it can be said that either of two conclusions can be reasonably drawn from the evidence, it is immaterial, upon appeal, that one of such conclusions appears to be more likely than the other, and we are bound by the finding of the trier of fact. However, when ... the conclusion reached by the fact finder simply cannot be reasonably arrived at under the evidence, that is to say that no reasonable person could draw such conclusion from the evidence, then the judgment resting thereon is contrary to law and cannot stand. (citing cases) (Emphasis supplied).

Traina, 486 N.E.2d at 1022.

The trial court here satisfied Addington's due process requirements. Its Finding of Fact No. 2 says

2) The State of Indiana had the burden of proving, by clear and convincing evidence, that Respondent suffered from a mental illness which resulted in either the respondent's grave disability or dangerousness. (Emphasis supplied).

Our duty, then, is to review

(a) the evidence to determine whether there is substantial evidence supporting each finding of fact, then

(b) the findings as a whole to determine whether they support the conclusions reached by the trial court namely,

(1) M.P.'s hospitalization should be continued, and

(2) because M.P. currently cannot make rational choices as to his course of treatment medication to correct his condition may be forced upon him by hospital personnel.

If these were conclusions a reasonable person could draw from those findings, we will affirm. If no reasonable person could draw such conclusions, the judgment is contrary to law and cannot stand. Traina, 486 N.E.2d at 1022.

2. Continued Hospitalization.

A. Hearsay in Business Records.

M.P. argues it was error to admit M.P.'s hospital admission records because they contained numerous hearsay comments by his relatives who were under no business duty to make them for the record. Because they contain such hearsay, these records are inadmissible, M.P. opines, citing Burger Man, Inc. v. Jordan Paper Products, Inc. (1976), 170 Ind.App. 295, 352 N.E.2d 821, in support of that proposition. We disagree.

First, hospital records containing statements reasonably pertinent for proper diagnosis are admissible. Breeding v. Dodson Trailer Repair, Inc. (1984), Mo.Sup., 679 S.W.2d 281, 284-285. Dr. Stoner used these records for diagnostic purposes.

Next, Indiana has rejected the hearsay argument as to expert witnesses. In this state, an expert witness can draw upon all sources of information coming to his knowledge or through the results of his investigation in order for him to formulate an opinion. The hearsay an expert considers must be of a type normally found reliable and customarily relied upon by him in the practice of his profession. Kranda v. Houser-Norborg Medical Corp. (1981), Ind.App., 419 N.E.2d 1024, 1034, reh. den'd. 424 N.E.2d 1064; appeal dismissed 459 U.S. 802, 103 S.Ct. 23. Accord, Breeding, 679 S.W.2d 284-285; Federal Rules of Evidence, Rule 803(4).

Finally, business records made in the regular course of business when properly identified are admissible even though they contain hearsay, as an exception to the hearsay rule. Burger Man, Inc., 352 N.E.2d at 830.

The court correctly continued M.P.'s hospitalization. Cf. IC 16-14-9.1-10(d).

We find no error here.

3. Forced Medication with Antipsychotic Drugs.

M.P. next argues the trial court erred by authorizing his enforced medication with antipsychotic drugs if he refuses to take them voluntarily. He claims a competent, involuntarily committed mental patient has a constitutional right to refuse medication, absent an emergency situation. The State in oral argument agrees such a constitutional right exists, but suggests the question of whether such a patient can be forcibly medicated against his will "appears to be a mixed question of constitutional law, statutory construction, and sufficiency of the evidence." Both parties indicate this question is one of first impression in this state, as indeed it is.

A. The Constitutional Right to Refuse Medication.

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