Tarpley, Matter of

• Decision Date: 05 February 1991
• Docket Number: No. 49A02-9004-CV-219,49A02-9004-CV-219
• Court: Indiana Appellate Court
• Parties: In the Matter of the Mental Commitment of Timothy TARPLEY, Appellant (Respondent Below).

Page 71

566 N.E.2d 71

In the Matter of the Mental Commitment of Timothy TARPLEY,

Appellant (Respondent Below).

No. 49A02-9004-CV-219.

Court of Appeals of Indiana,

Fourth District.

Feb. 5, 1991.

Kenneth J. Falk and Lisa R. Hayes, Legal Services Organization of Indiana, Inc., Indianapolis, for appellant.

William E. Daily, Deputy Atty. Gen., Office of Atty. Gen. and J. Michael Grubbs, Locke, Reynolds, Boyd & Weisell, Indianapolis, for appellees.

CONOVER, Judge.

Respondent-Appellant Timothy Tarpley (Tarpley) appeals an order from the Marion County Municipal Court. He also appeals a contempt conviction arising from a hearing before the court.

We affirm.

Tarpley raises the following consolidated and restated issues:

1. whether the trial court erred in ordering Tarpley to take medication; and

2. whether the trial court erred in finding Tarpley in contempt for refusing to take medication as ordered.

Tarpley is a thirty-three year old resident of Indianapolis with a history of dangerous behavior due to chronic paranoid schizophrenia. He was originally committed on January 8, 1987, as an outpatient at Midtown Community Health Center (Midtown), after the court found he was gravely disabled. ¹ He was committed as an outpatient on the condition he take all medications as prescribed, attend all clinic sessions, and refrain from abusing drugs or alcohol.

Tarpley began violating the conditions of his commitment almost immediately. He frequently refused to take medication, and informed the court and Midtown of the refusals. During the course of his commitment several proceedings took place regarding these refusals. On one occasion the court initially held him in contempt, but upon finding he was psychotic, purged his record of contempt. Upon this finding, the court converted his commitment to inpatient status for the purpose of insuring he take his medication.

Tarpley was discharged from the inpatient unit on February 11, 1987, but again failed to take required medication. On March 20, 1987, he was found in contempt for not taking it, and was sentenced to ten days in the Marion County Jail. The sentence was suspended when he agreed to take his required medication.

The court's coercive approach secured Tarpley's compliance with the medication schedule recommended by Midtown and ordered by the court. As a result, Tarpley was able to function in the least restrictive environment necessary to prevent harm to himself and others. Even though his commitment was continued in January of 1988, the court saw no need to place him on the more restrictive inpatient status since his compliance with the court ordered conditions made it possible for him to function outside the confines of a mental institution.

During the next several months, Tarpley's capacity to function reached its highest point in the history of his commitment. He held a regular job as a data entry operator, maintained his own apartment, and took classes.

His commitment was again extended in January of 1989. However, in September of 1989, the court was forced to hold a commitment review hearing after Midtown reported Tarpley was missing clinic appointments. After finding Tarpley presented a danger to himself and others, the court continued Tarpley's commitment. It also ordered Midtown to re-evaluate Tarpley's medication needs, investigate his complaints regarding the effects of overmedication, and submit a new treatment plan.

In October of 1989, Midtown filed a new treatment plan recommending continued medication every four weeks during clinic visits. By this time, however, Tarpley had decompensated and was no longer able to work. On October 24, 1989, Midtown reported Tarpley was refusing to take medications and was decompensating further. On October 25, 1989, a Mental Health Summons was issued to Tarpley. The summons warned that a proceeding for commitment had been instituted which could result in commitment as an inpatient at a mental health facility.

On the same date, the trial court also issued an "Order Setting Hearing for Show Cause", which set a hearing date. The order further stated:

The hearing shall determine if the patient is mentally ill and dangerous or is mentally ill and gravely disabled (as those terms are defined in IC 16-14-9.1) and if so, to which facility the patient shall be recommitted. The Court will also hear evidence upon other matters pertaining to the patient's care and treatment if any such matters are brought to the Court's attention at the hearing.

(R. 89). It also appointed an attorney to represent Tarpley at the hearing.

The hearing was continued until December, 1989. On December 28, a hearing was held in which the trial court found "the evidence is very convincing that Mr. Tarpley is mentally ill, that [if] Mr. Tarpley is not treated [he] is going to relapse and if he does relapse he could act out in a dangerous manner." (R. 235).

The court heard uncontroverted testimony which established the least restrictive treatment for Tarpley would be to continue to allow him to function as an outpatient, while requiring him to take medication. The only other viable alternative was to commit Tarpley to a mental facility as an inpatient. The court informed Tarpley he was to continue to take medication, and his outpatient status depended on his compliance with the court's order to take medications. The court further indicated that any failure upon Tarpley's part to take medication could result in contempt findings and incarceration or commitment as an inpatient. The court then directly ordered Tarpley to take medication, and in response to questions from Tarpley's attorney, stated failure to take medication could result in a finding of contempt.

After the hearing adjourned, the parties left the courtroom and congregated outside the judge's chambers. While outside chambers, Tarpley said he would not comply with the court's order. Tarpley, his counsel, and counsel for Midtown reentered the courtroom. There, the following discussion ensued:

THE COURT: Mr. Tarpley?

MR. TARPLEY: I was told by the Doctor and Joy Bennett that I had to tell you. Medicine is out, and seeing that I have not disobeyed court orders to appear here are [sic] anything and you're sending me to jail for not taking medication ...

THE COURT: No I am not sending you to jail I just told you to go downstairs and take your medication, now if you are telling me that you are not going to take your medication then ask the Doctor. Is there any other way we can do this Doctor?

DR. SCHMETZER: Your Honor I know of no other besides the medication is going to be helpful as a part of Mr. Tarpley's treatment program, that's why we are here today.

THE COURT: Mr. Hiland [Tarpley's attorney], do you have any suggestions?

MR. HILAND: Your Honor I have talked with Mr. Tarpley both before and after the hearing. I understand Tim's position as to the issue, I believe he understands the consequence of his decision, I believe it is a voluntarily [sic] and knowingly [sic] decision. For what it is worth I concur with his decision.

THE COURT: All right, Court at this time finds Mr. Tarpley in contempt, Mr. Tarpley will go to jail and he will remain there until he purges himself of the contempt.

(R. 245-247).

Tarpley continued to refuse medication while he was in jail. He was released from jail on January 25, 1990, on the condition he continue his commitment as an outpatient. On the same date, he filed a praecipe for a transcript of the record.

Tarpley contends the trial court erred when it ordered him to take his medication or suffer the consequences. He contends that under In re Mental Commitment of M.P. (1987), Ind., 510 N.E.2d 645, the court has only the authority to allow Midtown to forcibly medicate, not to require Tarpley to take the medication. We disagree.

The issue before our supreme court in Commitment of M.P. was whether M.P. could be forcibly medicated. The court determined a trial court could override a patient's statutory right to refuse treatment when clear and convincing evidence showed: 1) a current and individual medical assessment of the patient's condition had been made; 2) the assessment resulted in the honest belief of the psychiatrist that the medications would be of substantial benefit in treating the condition suffered, and not just in controlling the behavior of the individual; and 3) the probable benefits from the proposed treatment outweighed the risk of harm to, and personal concerns of, the patient. Id., at 647. When a trial court finds the necessary evidence is present, it can then order the patient to be forcibly medicated.

Here, Tarpley does not attack the sufficiency of the evidence supporting the court's authority to require him to take the medication, but only questions the court's method of insuring the medication is taken. Stated differently, Tarpley contends once the need for medication is established, Commitment of M.P. gives the trial court only the option of allowing the treatment facility to forcibly administer medication, and not the option of ordering the patient to take medication.

Once the court has found the evidence is sufficient to establish the necessity of medication, the goal of the trial court in reviewing treatment plans is to insure the least restrictive reasonable treatment be selected and implemented. Commitment of M.P., at 647. The least restrictive reasonable treatment is treatment which restricts the patient's liberty to the least degree possible, and yet, is still workable. Id. In the present case, after finding sufficient evidence warranting the medication schedule, the trial court had three treatment alternatives. It could convert Tarpley's commitment to inpatient status and order medication be forcibly given. It could order Tarpley remain an outpatient and show up for periodic forced medications. Finally, it could order Tarpley to take medication or suffer the consequences. The first alternative was clearly...