A.S. v. Ind. Univ. Health Bloomington Hosp.

• Decision Date: 18 May 2020
• Docket Number: Court of Appeals Case No. 19A-MH-3044
• Citation: 148 N.E.3d 1135
• Parties: A.S., Appellant-Respondent, v. INDIANA UNIVERSITY HEALTH BLOOMINGTON HOSPITAL, Appellee-Petitioner
• Court: Indiana Appellate Court

148 N.E.3d 1135

A.S., Appellant-Respondent,

v.INDIANA UNIVERSITY HEALTH BLOOMINGTON HOSPITAL, Appellee-Petitioner

Court of Appeals Case No. 19A-MH-3044

Court of Appeals of Indiana.

FILED May 18, 2020

Attorneys for Appellant: Michael E. Hunt, Rachel M. Rogers, Monroe County Public Defender, Bloomington, Indiana

Attorneys for Appellee: James L. Whitlatch, Kathryn DeWeese, Bunger & Robertson, Bloomington, Indiana

May, Judge.

[1] A.S. appeals following her 90-day commitment to Indiana University Health Bloomington Hospital ("Hospital").¹ A.S. raises four issues, which we consolidate, reorder, and restate as:

1. Whether the trial court abused its discretion by admitting hearsay evidence;

2. Whether the evidence was sufficient to support the trial court's determinations that A.S. was gravely disabled and a danger to herself; and

3. Whether the trial court erred in determining the treatment plan imposed was the least-restrictive plan available.

We affirm.

Facts and Procedural History

[2] On November 26, 2019, Hospital filed an Application for Emergency Detention of a Mentally Ill and Dangerous or Gravely Disabled Person regarding A.S. The Application indicated A.S. was "psychotic and she has been walking in the middle of the highway multiple times." (App. Vol. II at 8.) The court granted the emergency detention that day.

[3] On November 27, 2019, Hospital petitioned for temporary involuntary commitment of A.S. The court heard evidence and argument on December 3, 2019, and it entered an order for temporary commitment that same day. The trial court found A.S. to have schizophrenia

, which rendered her both dangerous to herself and gravely disabled. The order permitted Hospital to keep A.S. for up to 90 days, provided Hospital permission to draw blood from A.S. as necessary for laboratory tests, and granted Hospital authority to treat A.S. with anti-psychotic medications.

Discussion and Decision

[4] Civil commitment proceedings have two purposes – to protect both the public and the rights of the person for whom involuntary commitment is sought. In re Civil Commitment of T.K. , 27 N.E.3d 271, 273 (Ind. 2015). "The liberty interest at stake in a civil commitment proceeding goes beyond a loss of one's physical freedom," id. , because commitment is accompanied by "serious stigma and adverse social consequences[.]" Id. Accordingly, proceedings for civil commitment are subject to the requirements of the Due Process Clause. Id. (citing Addington v. Texas , 441 U.S. 418, 425-26, 99 S.Ct. 1804, 60 L.Ed.2d 323 (1979) ).

1. Admission of Evidence

[5] A.S. asserts "[t]he trial court erroneously admitted inadmissible hearsay evidence ...." (Appellant's Br. at 8.) We review the trial court's admission of evidence for an abuse of discretion. Henderson v. Henderson , 139 N.E.3d 227, 236 (Ind. Ct. App. 2019). An abuse of discretion occurred if the trial court's decision was clearly against the logic and effect of the facts and circumstances before the court. Id.

[6] In particular, A.S. points to statements made by the police who brought her to the emergency room for detention, and she claims "all information used to detain, and then commit, A.S.,[sic] was communicated through a loop that started with the police and ended with Dr. Mayer, without him ever speaking directly to them." (Appellant's Br. at 25.) Thus, A.S. asserts, Dr. Mayer's testimony about what the police reported was inadmissible hearsay² that could not meet the criteria for admission under the exception for a "Statement Made for Medical Diagnosis or Treatment."³ Ind. Evidence Rule 803(4).

[7] When Hospital called its psychiatrist, Dr. Carey Mayer, to the stand, Hospital's counsel asked if A.S. was "willing to stipulate to the fact that Dr. Mayer is a board certified psychiatrist qualified to render his medical opinion." (Tr. Vol. II at 4.) Counsel for A.S. responded, "Yes[.]" (Id. ) Dr. Mayer testified he is A.S.'s "attending psychiatrist" and had "seen her daily since" her admission on November 26, 2019. (Id. at 5.) Dr. Mayer also testified he diagnosed A.S. as having schizophrenia

based on her behavior at Hospital and based on information gathered from other sources, including Hospital's Emergency Department, A.S.'s family, and police reports. The following exchange then occurred:

[Hospital Counsel]: What, to start off, what behaviors have you observed since she's been here on the unit?

[Dr. Mayer]: Well she acts very inappropriately. She's invariably agitated, has made delusional statements such as that she is Jesus. She was [sic] actually came to the attention of the police when she was walking in traffic. My understanding is that there was [sic] actually some car wrecks that were created by that. Police were called and she had made comments to the police and or

[A.S. Counsel]: I would object to this. There was no direct observation, I believe.

[The Court]: Your response, Counsel?

[Hospital Counsel]: Doctor, is this type of information, police reports, reports from other practitioners, other providers, is that information, family members, is that information that you typically rely on in reaching a diagnosis?

[Dr. Mayer]: Yes.

[The Court]: For purposes, for diagnostic purposes, I will allow the testimony.

(Id. at 6-7.)

[8] Thus, contrary to A.S.'s assertion, the trial court did not admit into evidence Dr. Mayer's repetition of what the police reported. Instead, the trial court allowed Dr. Mayer to explain what the police reported "for diagnostic purposes." (Id. at 7.) Pursuant to Evidence Rule 702(a), a witness "who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise if the expert's scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue." Furthermore, when a witness has been qualified as an expert under Rule 702, that person "may base an opinion on facts or data in the case that the expert has been made aware of or personally observed. Experts may testify to opinions based on inadmissible evidence, provided that it is of the type reasonably relied upon by experts in the field." Evid. R. 703.

[9] Here, when Dr. Mayer took the stand, A.S. stipulated that he was an expert qualified to give a medical opinion. (See Tr. Vol. II at 4.) Dr. Mayer also testified that police reports were one of the items typically relied on when rendering a mental health diagnosis. (See id. at 6.) As a result, Evidence Rule 703 allowed Dr. Mayer to rely on the police report when determining a diagnosis for A.S. The trial court allowed Dr. Mayer to testify about the information from the police report not for evidentiary purposes but to explain how he reached his diagnosis. We presume that "trial courts know and follow the law," Hecht v. Hecht , 142 N.E.3d 1022, 1031 (Ind. Ct. App. 2020), and that a judge considers only the properly-admitted evidence when rendering a judgment. See Konopasek v. State , 946 N.E.2d 23, 28 (Ind. 2011) ("We generally presume that in a proceeding tried to the bench a court renders its decisions solely on the basis of relevant and probative evidence."). A.S. has not demonstrated error in the trial court's allowing Dr. Mayer to state what the police reported in order to explain his opinion about A.S.'s diagnosis.

2. Sufficiency of Evidence

[10] To comport with due process requirements, a person may not be committed without clear and convincing evidence in support thereof. In re T.K. , 27 N.E.3d at 273. When we review a determination made under that clear and convincing standard, we 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.’ " Id. (quoting Bud Wolf Chevrolet, Inc. v. Robertson , 519 N.E.2d 135, 137 (Ind. 1988) ).

[11] To have a person committed, the petitioner – here, Hospital – must 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). Because the statute is written in the disjunctive, a petitioner need only prove the respondent is "either dangerous or gravely disabled." Id. (emphasis added); see also M.Z. v. Clarian Health Partners , 829 N.E.2d 634, 637 (Ind Ct. App. 2005) ("It is important to note that in order to carry its burden of proof, Clarian only had to prove that M.Z. was either gravely disabled or dangerous. It did not have to prove both of these elements.") (emphasis in original), trans. denied .

[12] For purposes of Indiana Code article 12-26, mental illness means "a psychiatric disorder that: (A) substantially disturbs an individual's thinking, feeling, or behavior; and (B) impairs the individual's ability to function." Ind. Code § 12-7-2-130. Dangerous is defined as "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." Ind. Code § 12-7-2-53. Gravely disabled means

a condition in which an individual, as a result of mental illness, is in danger of coming to harm because the individual:

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

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

Ind. Code § 12-7-2-96. Because the definition of grave disability is written in the disjunctive, the evidence needs to support only one of those two prongs for a person to be found gravely disabled. See A.L. v Wishard Health Servs. , 934 N.E.2d 755, 760 (Ind. Ct. App. 2010) ("When Indiana Code section 12-7-2-96(2) is at issue, the trial court need not find that the person in...