Opinion
24A-MH-835
09-06-2024
Commitment of M.B., Appellant-Respondent, v. Richard L. Roudebush Veterans Affairs Medical Center, Appellee-Petitioner.
Attorney for Appellant Talisha R. Griffin Appellate Division Chief Marion County Public Defender Agency Indianapolis, Indiana Attorney for Appellee Elizabeth C. Rogers Special Assistant United States Attorney Veterans Administration Indianapolis, Indiana
Pursuant to Ind. Appellate Rule 65(D), this Memorandum Decision is not binding precedent for any court and may be cited only for persuasive value or to establish res judicata, collateral estoppel, or law of the case.
Appeal from the Marion Superior Court The Honorable David Certo, Judge Trial Court Cause No. 49D08-2402-MH-8954
Attorney for Appellant Talisha R. Griffin Appellate Division Chief Marion County Public Defender Agency Indianapolis, Indiana
Attorney for Appellee Elizabeth C. Rogers Special Assistant United States Attorney Veterans Administration Indianapolis, Indiana
MEMORANDUM DECISION
ROBB, SENIOR JUDGE
Statement of the Case
[¶1] M.B. is a thirty-three-year-old veteran who was first diagnosed with schizophrenia over nine years ago. He appeals the trial court's order of regular commitment, directing that he remain at the Richard L. Roudebush Veterans Affairs Medical Center (Hospital). M.B. challenges the sufficiency of the evidence supporting the court's determination that he is gravely disabled. Concluding that there is sufficient evidence supporting the court's order, we affirm.
Facts and Procedural History
[¶2] This case began on February 29, 2024 when the Hospital filed an "Application for Emergency Detention of Mentally Ill. and Dangerous and/or Gravely Disabled Person" requesting the court authorize a continued emergency detention. Appellant's App. Vol. II, pp. 13-15 (application). The trial court granted the application. Id. at 16-18 (order). On March 4, 2024, the Hospital filed a petition for involuntary commitment, and a commitment hearing was held on March 14, 2024.
[¶3] Dr. Ifeoluwa Ladapo, a resident psychiatrist at the Hospital who was licensed to practice medicine in Indiana, first examined M.B. on March 6, 2024. Between March 6 and the date of the hearing, Dr. Ladapo met with M.B. approximately seven times, including the morning of the hearing.
[¶4] During the initial examination, Dr. Ladapo observed M.B. to be slightly disorganized, suffering from delusions and hallucinations, and responding to internal stimuli. As an example of responding to internal stimuli, Dr. Ladapo noted she saw M.B. have conversations with people who were not present. She also observed him continuously picking at a scab located near his mouth. When she questioned him about it, he stated that he believed he needed to "get the poison out of his wound." Tr. Vol. II, p. 15. He also reported to her that on one occasion, "the TV was speaking in his voice and commanding everyone else" there. Id. M.B. acknowledged that he was admitted to the Hospital because law enforcement officers were called to his apartment complex after he flooded his apartment and the apartment below his. Ultimately, M.B. was evicted from his apartment.
[¶5] Dr. Ladapo diagnosed M.B. with schizophrenia, a diagnosis he had carried for nine years. She reached her conclusion because M.B. exhibited symptoms including delusions, hallucinations, disorganized speech, disorganized behavior, and negative symptoms, all of which are criteria for a schizophrenia diagnosis.
[¶6] Through these interviews, Dr. Ladapo learned that M.B. "buys something called holy wood that he burns in his house to help him feel better[.]" Tr. Vol. II, p. 12. She also learned that "he sometimes does not like to eat food that he believes has been poisoned" and will dump the food down the toilet or a drain in the sink when the food "tastes weird or smells weird" because "he believes that would mean it's poisoned." Id.
[¶7] M.B. continued to suffer from delusions while at the Hospital. He disclosed that he isolated himself in his room because "he believes that everyone else . . . is trying to bully him[.]" Id. at 15. Dr. Ladapo testified that M.B. had no insight into his mental illness, and he disputed his diagnosis. For example, he told her that multiple people have told him he does not have schizophrenia. Dr. Ladapo opined that without insight into his diagnosis, M.B. would not take his medications, which would result in continued delusions, hallucinations, and paranoia. According to her, this would impede his ability to engage in appropriate daily living.
[¶8] She further opined that based on M.B.'s past and present schizophrenic behavior, he would not be able to engage in any discharge planning. M.B. was unable to engage in normal conversations, refused to take his medication while at the Hospital, and had been evicted from his apartment. He did not sleep regularly and often paced in his room instead. Additionally, he did not eat regularly, but could not explain why. And M.B. was not engaging in basic hygiene needs by refusing to shower regularly.
[¶9] Moreover, she testified that based upon M.B.'s isolation while at the Hospital, he would not participate in follow-up care. She also opined that M.B. would not be able to care for himself. More specifically, she stated that M.B. suffered from a substantial impairment or obvious deterioration of judgment, reasoning, or behavior that resulted in his inability to function independently. This conclusion was based on M.B.'s paranoia and delusionary symptoms, including his continued belief that his food was poisoned, and picking at the facial scab to release poison (which he engaged in on the day of the hearing).
[¶10] Furthermore, Dr. Ladapo testified she believed M.B.'s delusions and paranoia would prevent him from independently finding suitable housing. M.B. told Dr. Ladapo that he did not feel safe in Indianapolis. And he testified at the hearing about his desire to relocate to Greenwood or North Carolina. He said, "it seems more pleasant in Greenwood." Id. at 33. As for North Carolina, he said he "was doing a lot better [there because he] had a . . . scholarship out there when [he] was on the track team ...." Id.. He also said he served in the military in North Carolina and "Parris Island, South Carolina." Id. at 34.
[¶11] The trial court also took judicial notice of M.B.'s prior commitments in two separate cause numbers: 49D08-1807-MH-25903, and 49D08-1905-MH-20146.
[¶12] M.B. testified at the hearing. He stated that he had breakfast that morning before the hearing, even though he told Dr. Ladapo, when he met with her that morning at 8:15 a.m., that he had not eaten breakfast. Breakfast is normally served at around 7:00 a.m. He also blamed the medications he was on for making him too tired to awaken in time to eat breakfast when it was served. M.B. testified that he had taken a shower that morning, even though he told Dr. Ladapo during their pre-hearing meeting that he was unsure of the last time he showered, but that it was "probably two days ago." Id. at 24.
[¶13] During the hearing, M.B. interjected indecipherable comments during Dr. Ladapo's testimony and became confused about whether he had been asked a question during her testimony. When asked about his eviction, M.B. stated "I wasn't really evicted the first time that I was just told to leave." Id. at 29. When asked about dumping his food down the toilet or drain in the sink, M.B. replied that he tried to do it carefully. And he claimed that the clogged drain occurred because the other side of the drain was blocked. When asked about burning wood in his apartment, M.B. said that he did so during the colder months. He testified that he did not have a plan for where he would live if he were released from the Hospital and that he would "have to pay for another storage place probably." Id. at 33. He also explained that he did not take his medication due to concerns about developing "Parkinsonian symptoms" and attempted to distinguish those symptoms from those exhibited by people, such as Michael J. Fox, who have Parkinson's disease. Id. at 35.
[¶14] At the conclusion of the hearing, the court found M.B. was suffering from schizophrenia and was gravely disabled as defined by Indiana Code section 127-2-96 (1992). Accordingly, the court entered its order of regular commitment.
Discussion and Decision
[¶15] M.B. challenges the court's conclusion that he is gravely disabled. Indiana Code section 12-7-2-96 provides that a person is gravely disabled if as a result of a mental illness the individual 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." Here, we are concerned with the second prong, because the court found that M.B. "is gravely disabled in his judgment and reasoning by schizophrenia, including delusions that his food is poisoned and that fires he set in apartment made him feel better." Appellant's App. Vol. II, p. 12. The court additionally found that M.B. "has multiple prior commitments and orders for apprehension &return after failing to comply with medications." Id.
[¶16] "In reviewing the sufficiency of the evidence supporting a determination made under the statutory requirement of clear and convincing evidence, an appellate court will 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.'" Civil Commitment of T.K. v. Dep't of Veterans Affairs, 27 N.E.3d 271, 273 (Ind. 2015) (quoting Bud Wolf Chevrolet Inc. v. Robertson, 519 N.E.2d 135, 137 (Ind. 1988)). "This appellate standard of review applies in civil commitment decisions." T.K., 27 N.E.3d at 273.
[¶17] Civil commitment proceedings serve two purposes: (1) to protect the public and (2) to protect the rights of the person for whom commitment is sought. A.S. v. Indiana Univ. Health Bloomington Hosp., 148 N.E.3d 1135, 1138 (Ind.Ct.App. 2020). Because the liberty interest at stake in civil commitment proceedings encompasses more than a loss of one's physical freedom, such proceedings are subject to the requirements of the Due Process Clause. Id. (quoting T.K., 27 N.E.3d at 273.
[¶18] The Hospital was required to prove by clear and convincing evidence that M.B. is (1) mentally ill, (2) either dangerous or gravely disabled, and (3) that his commitment is appropriate. See Ind. Code § 12-26-2-5(e) (2007). M.B. does not dispute the trial court's finding that he is mentally ill. However, M.B. challenges the sufficiency of the evidence that he "was gravely disabled at the time of the trial court's finding." Appellant's Br. p. 9 (emphasis added). We disagree.
[¶19] We acknowledge that "the statutory language looks to the patient's behavior at the time of the hearings, not to his history." Commitment of M.E. v. Dep't of Veterans Affairs, 64 N.E.3d 855, 863 (Ind.Ct.App. 2016), disapproved of on other grounds by A.A. v. Eskenazi Health/Midtown CMHC, 97 N.E.3d 606, 611-12 (Ind. 2018) (mental illness is distinguished from mental competency and must not be conflated)). We also acknowledge that the "denial of illness and refusal to medicate, standing alone, are insufficient to establish grave disability because they do not establish, by clear and convincing evidence, that such behavior 'results in the individual's inability to function independently.'" T.K., 27 N.E.3d at 276 (quoting Ind. Code § 12-7-2-96(2)). And "we do not believe that aggression or paranoia, alone, establish an inability to function independently." M.E., 64 N.E.3d at 863.
[¶20] However, just because those factors cannot be utilized "alone" or "standing alone" to support an order of commitment, does not necessarily mean that those factors should be discounted. Instead, we believe it is reasonable to consider the context of those factors, which includes background information to provide that context. What is of added importance is why the person is not taking the medicine, for example. Here, M.B. was not taking his medication because he had no insight into his diagnosis and contended others believed he did not suffer from schizophrenia. Dr. Ladapo stated that without insight into his diagnosis, coupled with M.B.'s refusal to take his medications, M.B. would remain delusional, paranoid, and suffering from hallucinations. Those delusions, hallucinations and paranoia led to his refusal to eat food because of his belief it was poisoned, which in turn led to him disposing of the food in an inappropriate manner. The flooding from the clogged pipes as a result of that behavior led to his eviction. And instead of adjusting the thermostat, M.B. burned "holy wood" in his apartment to feel better during colder months. M.B. also claimed that the medication did not make him feel well, and that he suffered side effects from them, yet he was unable to describe what the side effects were. Moreover, Dr. Ladapo stated that M.B. had done well on the medications in the past. The court had more than just the fact of M.B.'s denial of his illness and the fact of M.B.'s refusal to take his medications standing alone, but also the context explaining the nexus between those behaviors and why he is unable to function independently.
[¶21] The trial court observed M.B. during his testimony and concluded that M.B.'s "testimony to the court has been rambling and disorganized indicating that he has no plan for housing, he has an aspiration maybe to go to North Carolina or maybe a place where people are nicer to him that reflects his disorganization and lack of insight." Tr. Vol. II, p. 47. The court also noted M.B.'s admission "that he put food down his toilet and down his sink, not intending to cause any harm or flooding but he set fires in his apartment again not planning to do any damage." Id. at 47-48. The trial court remarked that those behaviors resulted in his eviction and reflected "not just a lack of safety for him but a lack of safety for others[.]" Id. at 48. The court reasoned that, after his eviction for such behavior, "rather than denying he ever intends to do anything like it again, [M.B.] has tried to explain his conduct and his explanations make no sense." Id.. Thus, the trial court's statements demonstrate that its conclusion was reached by recognizing the nexus between M.B.'s impaired judgment and reasoning and how it affects his ability to function independently without harming himself or others.
[¶22] The court's statements during the hearing show the court's decision was based upon M.B.'s current condition at the time of the hearing. And to the extent M.B. challenges certain particular findings, we conclude that those challenges constitute impermissible requests for us to reweigh the evidence. See T.K., 27 N.E.3d at 273. Therefore, we conclude there is sufficient evidence to support the trial court's judgment.
Conclusion
[¶23] In light of the foregoing, we affirm the trial court's judgment.
[¶24] Affirmed.
Brown, J., and Kenworthy, J., concur.