IN RE: the Commitment of: D.C. (2024)

MEMORANDUM DECISION

[1] D.C. appeals his involuntary civil commitment and claims it was not supported by sufficient evidence. We affirm.

Facts and Procedural History

[2] D.C. is sixty-nine years old and has been married to seventy-four-year-old H.C. for forty-four years. They have two adult sons. D.C. and H.C. lived in Indianapolis until April 2024, when they moved to Lebanon, Indiana. D.C. has a longstanding diagnosis of Bipolar Disorder with psychotic features.

[3] On August 27, 2024, D.C. was admitted to Indiana University Methodist Hospital (the “Hospital”) on a “a community-initiated [emergency detention order] from his outpatient psychiatrist, due to erratic behaviors, paranoid ideation, and threatening statements and actions toward the family.” Expedited Transcript Volume I at 26. Thereafter, the Hospital filed a petition seeking a temporary mental health commitment. The court held a hearing on September 4, 2024. In support of the temporary commitment, the Hospital presented the testimony of one of D.C.’s sons, M.C., H.C., and the expert testimony of Dr. Claryce Gedde.¹

[4] M.C. testified that, on the last Saturday in July, he received a concerning phone call from his mother which prompted him to go to his parents’ home. D.C., who had a history of “bipolar paranoid behavior,” was acting “very strange,” and M.C. learned that D.C. had called police, requesting an unmarked car and a female detective. Id. at 5. M.C. learned that D.C. was convinced that H.C. had been raped, which was not true as H.C. had no idea “what [D.C.] was talking about.” Id. As M.C. spoke with D.C. and tried to understand what was going on, D.C. was acting “erratic” and “bizarre,” believed he was communicating with M.C. through a song from “West Side Story,” and would stand up and do “strange movements” as he spoke. Id. M.C. also noticed that D.C had placed cameras all around the house. M.C. explained that based upon “the past 30 years of living with [D.C.] and being his son—knowing that he has a mental illness and knowing that usually if he's on medication, he's more stable,” M.C. tried to reason with D.C. about seeing a doctor and taking his medication. Id. at 6. D.C. said he “would absolutely not see a doctor” because “he's a Christian.” Id.

[5] M.C. stated that he and his brother went to the house the following week to confront D.C. about “taking his medication, seeing a doctor.” Id. at 7. During this visit, their mother told them that D.C. “wanted to go to Japan” and D.C. confirmed that he had already spent $11,000 on the trip and their luggage was packed. Id. During this interaction, M.C. observed that D.C. was paranoid and that his belief that H.C. had been raped was clearly the result of hallucinations D.C. was experiencing. Because the brothers were worried for both their parents’ safety because D.C. was not “in his right mind to go” anywhere, they begged D.C. to please not “drag mom off” to Japan. Id. at 7, 8. D.C. became “really angry,” stated that he was divorcing H.C., and went to the garage. Id. at 8. The brothers sat “stunned” due to the volatility of the conversation, but after a few minutes, M.C. came “to [his] senses” and went to find D.C. Id. He discovered D.C. in a running car, in the closed garage, with the car window rolled down. M.C. recognized this as a suicide attempt because D.C. had attempted suicide in “the same fashion” a few years prior. Id. After being discovered by M.C., D.C. fled the home. H.C. showed M.C. the full bottles of antipsychotic medication that D.C. had not been taking. M.C. called the police after his father fled, but was advised to “just wait” for D.C. to return rather than file a missing person's report. Id.

[6] M.C. testified that the next time he saw D.C. was in mid-August when he was doing a “wellness check” at his parents’ house when he learned they had returned after two weeks in Japan. Id. at 10. M.C. called the police for help when nobody answered their phones or the door. M.C., who had keys to the house, eventually entered the dark home with a flashlight, discovering his parents in the master bedroom. When D.C. realized police were outside the home, he “got angry fast,” “ran to the door,” and “yelled at them saying that they're trespassing.” Id. at 11. The police asked to see H.C. to verify that she was “okay.” Id. H.C. came out of the house, D.C. closed the door, and H.C. finally had the opportunity to call D.C.’s treating psychiatrist, Dr. Patel, “in private.” Id. The following morning, M.C., with the assistance of police, went to pick up H.C. and remove her from the home because D.C. was again acting “very bizarre.” Id. at 11. M.C. testified that police finally detained D.C. and took him to the Hospital approximately six days later on Monday, August 26, 2024.

[7] H.C. testified that “the last few months” D.C. had been acting “strange.” Id. at 16. She stated that he put alarms around the house, taped all the interior doors shut and put chairs and boxes against the doors, and placed cameras everywhere because he thinks “people are coming in from the attic.” Id. H.C. testified that D.C. will not let her walk anywhere inside the house without him because he thinks “somebody [is] gonna come attack” her. Id. at 19. H.C. stated that she believed that D.C. had not taken any prescribed medication, including his diabetes medication, since February.² When asked if she felt comfortable living with D.C. right now, H.C. responded, “But he need[s] your help ․ I know he's still sick.” Id. at 20. She testified that, “he waited too long to go see a doctor. We tried to go see [a] doctor, we tried to take medication. He didn't want any.” Id. When asked on cross-examination if she would help assure that he would take his medication as prescribed if he were to be released from the Hospital, H.C. responded, “No, he's stubborn and he[’s] not gonna take it” and he “needs more help.” Id. at 22.

[8] Dr. Gedde testified that she had been D.C.’s attending physician at the Hospital since his emergency detention. She confirmed his prior diagnosis of Bipolar Disorder with psychotic features. She stated that when he arrived, D.C. was in a manic episode. She described that he was “distractible” and “displaying flight of ideas ․ moving from topic to topic without any perceivable connection between the two.” Id. at 29. He was preoccupied with the false belief that he was at the Hospital because Lebanon police had put a warrant out for his arrest, and he further informed Dr. Gedde that he had made several police reports because he believed construction workers had been trespassing on his property. Dr. Gedde stated that D.C. had been prescribed the antipsychotic Abilify by his outpatient psychiatrist in the past and, when asked why he had stopped taking it, he continually denied that he had stopped taking it. Dr. Gedde testified that the Hospital had restarted oral Abilify and had very recently given D.C. a long-acting injectable form of Abilify.

[9] Dr. Gedde noted that, although D.C. had improved since his original detention, he was still experiencing “paranoid delusions” and had become quite guarded about the information he would relay to medical staff after learning that he would be appearing for a detention hearing. Id. at 28. Dr. Gedde explained that she believed an extended detention was needed because when a long-acting injectable form of medication is started, a “crossover period” is necessary when D.C. continues to take “the oral version of the pill” before efficacy can be assessed and it can be determined if any additional mood stabilizers are necessary “if his symptoms aren't controlled at that time.” Id. at 29. Dr. Gedde further opined that D.C.’s “insight and judgment are limited” and that this affected his ability to function independently. Id. at 30. She stated that he lacked “insight into his disorder to understand that he needs to continue taking his medications if he were to leave here today.” Id.

[10] D.C. testified on his own behalf. He testified that he had been taking his prescribed medication while in the Hospital and that specifically, regarding the oral Abilify, he would “gladly have [H.C.] dispense it to [him]” and “make whatever record” that he “took it.” Id. at 40. As he continued to testify, he became increasingly distracted and had difficulty directly answering the questions asked. When asked about M.C.’s account of his recent suicide attempt, D.C. denied M.C.’s account. D.C. began telling the court of his current plans to attend a three-year doctorate program in Japan.

[11] D.C. further advised the court not to believe any of H.C.’s sworn testimony regarding his behavior because she was “under duress” and “trauma” because she “was raped” and has a “split personality.” Id. at 49. D.C. proceeded to explain that H.C. is “not safe” due to her “split personality” and that she was the one that “needs to be treated.” Id. at 51. When asked if he has any weapons in the home, D.C. admitted that he keeps razor blades in a safe in his house. When asked if or why he had stopped taking his medication, D.C. admitted that he had stopped taking all medication, but he became irritated with the questioning and gave rambling, nonsensical answers regarding why he had stopped.³ When asked if he was in a manic state when he came to the Hospital, D.C. responded, “No, sir.” Id. at 54. The court then directly asked D.C., “When was your wife raped?” Id. D.C. stated, “I don't know. I think it may have happened while we moved here.” Id. D.C. proceeded to explain to the court that he believed that construction workers may have trespassed on his property and how he had repeatedly complained to Lebanon police. On redirect, D.C.’s counsel asked him, “What makes you think that your wife got raped?” Id. at 55. D.C. gave a long-winded, nonsensical answer fixating on the failures of the Lebanon police and accusing H.C. of being both suicidal and mentally ill. Id.

[12] At the conclusion of the hearing, the trial court found that: D.C. suffers from Bipolar Disorder with psychotic features which is a mental illness as defined by Ind. Code § 12-7-2-53; D.C. is gravely disabled as defined by Ind. Code § 12-7-2-96; D.C. is in need of custody, care and treatment at the Hospital, or other appropriate facility, for a period of time not to exceed sixty days; such placement is the least restrictive environment suitable for treatment and stabilization as well as protecting D.C.; and that the benefits of the treatment plan outweigh any risks of harm. Accordingly, the court issued an order involuntarily committing D.C. until November 3, 2024, unless discharged prior.

Discussion

[13] In Indiana, an individual who is alleged to be mentally ill and either dangerous or gravely disabled may be committed to a facility for not more than ninety days under Ind. Code Chapter 12-26-6. The petitioner is required to prove by clear and convincing evidence that the individual is mentally ill and either dangerous or gravely disabled and detention or commitment of that individual is appropriate. Ind. Code § 12-26-2-5(e). The clear and convincing evidence standard is an intermediate standard of proof greater than a preponderance of the evidence and less than proof beyond a reasonable doubt. T.D. v. Eskenazi Health Midtown Cmty. Mental Health Ctr., 40 N.E.3d 507, 510 (Ind. Ct. App. 2015). We consider only the evidence favorable to the judgment and all reasonable inferences drawn therefrom and do not reweigh the evidence or judge the credibility of witnesses. Id.

[14] “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.” A.S. v. Ind. Univ. Health Bloomington Hosp., 148 N.E.3d 1135, 1140 (Ind. Ct. App. 2020).

[15] D.C. does not challenge the trial court's finding that he is mentally ill. Rather, he argues the trial court's finding that he was gravely disabled is not supported by clear and convincing evidence. Specifically, D.C. claims that the court's finding “was grounded in concern that D.C. would not continue to take medication, which cannot alone justify an involuntary commitment.” Appellant's Brief at 7.

[16] D.C. cites generally to Civil Commitment of T.K. v. Dep't of Veterans Affairs, 27 N.E.3d 271 (Ind. 2015), in which the Indiana Supreme Court made clear that “denial of illness and refusal to medicate, standing alone, are insufficient to establish grave disability ․” 27 N.E.2d at 276. However, D.C.’s suggestion that the trial court found him to be gravely disabled merely because it did not find him “credible with regard to taking his medication” is an oversimplification of the record. Expedited Transcript Volume I at 58. The court heard the impassioned testimony of desperate family members, M.C. and H.C., regarding D.C.’s recent deterioration of judgment, impaired reasoning, lack of insight regarding his illness, refusal to take his prescribed medication for his mental and physical health, prior and very recent suicide attempts, and their current fear for his safety due to his erratic behavior caused by extreme paranoia and delusions. Indeed, when asked if she felt comfortable having D.C. released, H.C., D.C.’s spouse of forty-four years, pleaded with the court, “he need[s] your help ․ I know he's still sick ․ he need[s], need[s] more. Stay.” Id. at 20. H.C. was clear in her testimony that she did not believe that D.C. would continue with treatment if released from the Hospital.

[17] The court also heard the expert testimony of Dr. Gedde in which she opined that D.C. was unable to function independently because he lacked “insight into his disorder to understand that he needs to continue taking his medications if he were to leave here today.” Id. at 30.⁴ Most significantly, the court heard D.C.’s testimony, during which he clearly displayed a lack of insight and/or acceptance into the seriousness of his condition and the benefits of treatment, a complete denial of his recent dangerous behavior which included an incident that his son perceived to be a suicide attempt, and his continued steadfast paranoid and delusional thinking.

[18] D.C. attempts to downplay the evidence presented arguing that the “[t]estimony from the hearing suggests, at worst, that D.C. was guarded in some conversations and protective of his wife,” and that much of his behavior can be viewed as “quite common” and did not “put him or anyone else in danger of coming to harm.” Appellant's Brief at 8-10. This amounts to a request for us to reweigh the evidence and reassess witness credibility, which we may not do. Further, unlike the cases relied upon by D.C., this is not a case in which a decision ordering an involuntary commitment was made on the basis of mere idiosyncratic behavior, a few isolated instances of unusual conduct, or the hypothetical future deterioration of the individual's mental state without the requisite showing that the individual is presently in danger of coming to harm. See A.B. v. St. Vincent Hosp. & Health Care Ctr., Inc., 240 N.E.3d 166, 171 (Ind. Ct. App. 2024) (finding insufficient evidence to support commitment because establishment of grave disability “requires more than paranoid beliefs and bizarre behavior” and hospital failed to show respondent was in danger of coming to harm as a result of impaired judgment); Commitment of B.J. v. Eskenazi Hosp., 67 N.E.3d 1034, 1040 (Ind. Ct. App. 2016) (physician's testimony that patient's condition would deteriorate if he “does not stick with the treatment [ ] plan,” was insufficient to prove that patient was gravely disabled as it was based on patient's “hypothetical state based on future contingencies” as opposed to his present state at the time of the hearing).

[19] Based upon our thorough review of the record, which includes the videorecording of the detention hearing, we conclude that clear and convincing evidence supports the trial court's conclusion that D.C. is in danger of coming to harm because he has a substantial impairment or an obvious deterioration of judgment, reasoning, or behavior that results in his inability to function independently and therefore that he is gravely disabled.

[20] For the foregoing reasons, we affirm the trial court's Order of Temporary Commitment.

[21] Affirmed.

FOOTNOTES

1.   Although in his appellant's brief D.C. points out Dr. Gedde's status as a very recent medical school graduate and resident physician, his trial counsel stipulated at the hearing that she was an expert in the field of psychiatry.

2.   The record reveals that in addition to antipsychotic medication to treat his Bipolar Disorder and medication to treat his diabetes, D.C. is also prescribed medication to treat high blood pressure and cholesterol.

3.   For example, D.C. stated, “I just stopped—I just stopped.” Expedited Transcript Volume I at 53. He then began recounting how he did not want to get prescriptions from a specific doctor, stated that he should have “freedom of choice” to find a new doctor, offered to provide records from CVS, but maintained that he did not want to get refills from CVS. Id.

4.   Although D.C. characterizes Dr. Gedde's testimony as “equivocal” on the issue of grave disability, see Appellant's Brief at 8, we disagree based upon our review of the record. Moreover, as noted above, in addition to Dr. Gedde's testimony, the Hospital presented ample additional evidence in support of a finding of grave disability.

Brown, Judge.

Judges Tavitas and Weissmann concur. Tavitas, J., and Weissmann, J., concur.