IN RE: the Civil Commitment of: D.S. (2025)

MEMORANDUM DECISION

[1] D.S. appeals his temporary involuntary civil commitment to a hospital for treatment of his mental illness. We initially dismissed this appeal, finding it moot because D.S. had been released from the hospital and had not established any mootness exception. Civ. Commitment of D.S. v. Cmty. Health Network, Inc., 247 N.E.3d 753 (Ind. Ct. App. 2024) (mem.). But while D.S.’s petition to transfer was pending in the Indiana Supreme Court, that Court decided Civil Commitment of J.F. v. St. Vincent Hospital and Health Care Center, Inc., 256 N.E.3d 1260 (Ind. 2025).

[2] In J.F., our Supreme Court ruled that “timely appeals of temporary commitment orders generally do not become moot when the orders expire,” although there may be “an exceptional case” that is moot because it “won't carry the potential for any collateral consequences.” Id. at 1269. The Court also ruled it is “the appellee's burden to make that extraordinary showing.” Id. In a later published order, the Court granted D.S.’s petition to transfer, vacated our original decision in this appeal, and remanded “for further proceedings consistent with this Court's opinion in [J.F.].” Civ. Commitment of D.S. v. Cmty. Health Network, Inc., 257 N.E.3d 806 (Ind. 2025). Since that decision, the parties have not sought to file any supplemental briefs addressing J.F.’s revised mootness standard. We therefore rely on the parties’ original briefs.

[3] On remand, we find that the appellee, Community Health Network, Inc. (Hospital), has failed to prove that this is an exceptional case carrying no possible collateral consequences. Turning to the merits of D.S.’s claim, we conclude that D.S. has failed to show that insufficient evidence supports the trial court's temporary commitment order.

Facts

[4] Around the time of his hospitalization, D.S., 56, lived in Chicago, where he had an apartment and worked as a health care provider. A few days a week, he lived with his girlfriend, J.T., at her apartment in Fishers, Indiana.

[5] In the months before D.S.’s hospitalization, J.T. noticed changes in D.S.’s behavior that alarmed her friends and relatives. For instance, D.S., who was embroiled in a dispute with a suburban Chicago police chief, appeared before an Illinois municipal board to discuss a “hundred fifty-million-dollar lawsuit, a RICO case, [and] Rudy Guiliani.” Tr. Vol. II, p. 6.¹ His unusual comments were not well received, leading to what J.T. viewed as a deterioration in D.S.’s mental health.

[6] In another instance of unusual behavior, he disappeared from a social engagement and then reported he was kidnapped. He also sent “alarming” videos to J.T.’s friends and family, prompting them to express concerns for J.T. Id. at 7.

[7] D.S. was a prolific producer of phone videos, many of which were hostile in tone. For example, D.S. sent one video—directed at the suburban Chicago police chief with whom he was feuding—to a group comprised of “ten federal people that are observing” and “ten people who have committed felonies.” Id. at 36. D.S. suggested in other videos that he would become lieutenant governor of Indiana and that he was working with homeland security.

[8] While J.T. was at work in 2024, D.S. sent her “concerning videos” in which he appeared “very agitated and upset” at a Fishers parking garage. Id. at 10. D.S. told J.T. that he had spoken to Fishers police, and J.T. agreed to meet D.S. at the Fishers Police Department. From there, J.T. drove D.S. to Community Health Network's Behavioral Health Pavilion CRISIS center. Before entering the facility, D.S. “put on like twenty different lanyards.” Id. at 11. He later became disruptive when the facility's workers tried to check his vital signs.

[9] Hospital petitioned to detain D.S. on an emergency basis because D.S. was believed to have a “psychiatric disorder” and was “gravely disabled.” App. Vol. II, p. 13. The treating physician noted that D.S. reports that “he had been chased by a Mexican Cartel,” “was classified,” and works for 180 Governments.” Id. at 14. The physician also revealed that D.S. was “preoccupied with police force,” “endorsing manic and psychotic symptoms,” “lacks insight and judgment,” and was refusing medications. Id. The trial court found probable cause to grant the emergency detention request.

[10] Hospital petitioned for a commitment hearing and provided a physician's statement that D.S. was suffering from bipolar disorder, was gravely disabled, and needed a temporary commitment. During D.S.’s hospitalization, he experienced “elevated mood, euphoria, rapid and pressured speech, decreased[d] need for sleep, multiple delusions and agitation[, and] racing thoughts.” Tr. Vol. II, p. 19. He also had difficulty focusing or engaging in “a linear conversation.” Id. at 20. D.S. accused Hospital of intentionally depriving him of sleep and torturing him. He claimed to have written “the mental health act of America” in three hours while in the hospital. Id. at 21-22. D.S. also alleged that he hosted a show on the Air America network and stated that the first director of the Central Intelligence Agency (CIA)—an agency that has been in operation for nearly 80 years—had appeared on it.

[11] Hospital also explained that D.S.’s blood pressure was high and put him at risk for stroke and other complications, but D.S. refused to take medication to treat his condition while hospitalized. He similarly refused to take medications aimed at stabilizing his mental illness symptoms. D.S. advised other patients that they should refuse their medications too because they did not need them and did not belong in a hospital. He suggested that he call their families, presumably to tell them the same thing.

[12] During the testimony of other witnesses at the commitment hearing, D.S. often appeared agitated and made “unusual gestures.” Id. at 35. During his own rambling testimony, D.S. stated that he had lived with cancer since he was 16 years old—that is, continuously for 40 years. He also claimed that he was a confidential informant for homeland security for 22 years, adding that he was in line to be hired by the CIA after a change in presidential administration. He told the court, “[Y]ou'd be surprised what I have to do to make this country safe.” Id. at 49.

[13] The trial court found that D.S. was mentally ill with bipolar disorder, that he was gravely disabled, and that he needed custody, care, and treatment at Hospital for a period expected not to exceed 90 days. The court ordered D.S. to take medications as prescribed and to attend all clinical sessions as scheduled. The court also granted Hospital “an Order to Treat unless [D.S.] does not substantially benefit from the medications.” App. Vol. II, p. 10. D.S. appealed, but the temporary commitment order expired before his appeal was fully briefed.

Discussion and Decision

[14] D.S. challenges the sufficiency of the evidence supporting his temporary involuntary commitment. Although his temporary commitment expired while this appeal was being briefed by the parties, D.S. argues, among other things, that his appeal is not moot due to collateral consequences he will suffer from an unreviewed commitment. Hospital responds by claiming the record does not support D.S.’s claim of collateral consequences.

[15] We find that Hospital failed to meet its burden of showing that this is the “extraordinary” case in which the potential for collateral consequences does not exist. See J.F., 256 N.E.3d at 1269. Given this finding that this appeal is not moot under J.F., we address the merits of D.S.’s arguments and find the evidence was sufficient to support his commitment.

I. This Case Is Not Moot Under the J.F. Standard

[16] “A case is moot when the controversy at issue has been ended, settled, or otherwise disposed of so that the court can give the parties no effective relief.” E.F. v. St. Vincent Hosp. & Health Care Ctr., Inc., 188 N.E.3d 464, 466 (Ind. 2022). A moot appeal is subject to dismissal because the opinion is merely advisory if effective relief cannot be granted. Id. But as our Supreme Court recently declared, most timely appeals of temporary commitment orders are not moot even when the commitment has expired before appellate review occurs. J.F., 256 N.E.3d at 1269.

[17] D.S. claims he will suffer harmful collateral consequences from his temporary commitment if this Court does not address his appeal on the merits. We agree that in Indiana, a history of involuntary commitment is evidence supporting a finding of grave disability and that a prior commitment is a prerequisite for a regular commitment. Golub v. Giles, 814 N.E.2d 1034, 1039 (Ind. Ct. App. 2004); Ind. Code § 12-26-3-9 (providing that a regular commitment may be ordered for “an individual who has previously been the subject of a commitment proceeding”). Accordingly, we find Hospital has not shown that this case falls into the “exceptional” category of temporary commitment appeals that “won't carry the potential for any collateral consequences.” J.F., 256 N.E.3d at 1269.² We therefore turn to the merits of D.S.’s appeal.

II. The Evidence Supports D.S.’s Temporary Commitment

[18] D.S. claims clear and convincing evidence does not support the trial court's order temporarily committing him. In reviewing this claim, 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.” Civ. Commitment of T.K. v. Dep't of Veterans Affs., 27 N.E.3d 271, 273 (Ind. 2015) (quotations omitted). Clear and convincing evidence is an intermediate standard of proof that is greater than a preponderance of the evidence but 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).

[19] An individual may be involuntarily committed in Indiana if the petitioner proves 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, the petitioner need only prove that the individual is either dangerous or gravely disabled—not both—to carry the petitioner's burden of proof. A.P. v. Cmty. Health Network, Inc., 238 N.E.3d 704, 709 (Ind. Ct. App. 2024).

[20] Here, the trial court found that D.S. was mentally ill, having been diagnosed with bipolar disorder. The court further found that D.S. was gravely disabled and in need of custody, care, and treatment until July 7, 2024, unless discharged sooner. D.S. contends Hospital did not prove by clear and convincing evidence that he was gravely disabled. In this context, “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.

[21] D.S. views the trial court as having ruled that “D.S. was gravely disabled under the second prong of the grave disability statute due to his refusal to take medication for high blood pressure.” Appellant's Br., p. 13. He disputes such a finding by the trial court, arguing that the medical evidence surrounding D.S.’s high blood pressure diagnosis and refusal to take prescription medications for that condition was insufficient to constitute clear and convincing evidence of a grave disability.

[22] But D.S. incorrectly narrows the trial court's ruling. The court found that D.S. “is gravely disabled in his judgment and reasoning by delusions, including that the hospital is putting ‘jars of salt’ in his food and that [D.S.’s treating psychiatrist] wants him to commit suicide.” App. Vol. II, p. 10 (emphasis added).³ The trial court's ruling makes clear that it believed D.S. was gravely disabled by his delusions, which the court viewed as including, but not limited to, those relating to his high blood pressure diagnosis.

[23] In his reply brief, D.S. argues that even if the trial court based its finding of grave disability on more than the blood pressure-related evidence, the other evidence, too, did not establish his grave disability. D.S. contends the record fails to show that he was at risk of harm due to his mental illness, as required for a finding of grave disability under Indiana Code § 12-7-2-96. We disagree, finding that the record contains clear and convincing evidence that D.S. is in danger of coming to harm because, due to his delusions, he has a substantial impairment or an obvious deterioration of his judgment, reasoning, or behavior that results in his inability to function independently. See Ind. Code § 12-7-2-96(2).

[24] When J.T. first began dating D.S. two years earlier, he believed Hillary Clinton wanted to kill him. D.S.’s delusions escalated during the two months prior to his hospitalization. He sent “alarming” videos to J.T.’s friends and family. Tr. Vol. II, p. 7. D.S. also reported sending large numbers of videos—often “hostile”—to government officials and agencies and various felons. Id. at 7, 37. D.S.’s reports of being kidnapped during a social engagement, becoming lieutenant governor of Indiana, and operating as a confidential informant for homeland security for two decades reasonably appear to be among the escalating delusions that he was suffering.

[25] After adorning himself with 20 lanyards and entering the hospital, D.S. accused hospital staff of torturing him and intentionally depriving him of sleep. D.S. claimed that the first CIA director appeared on an Air America show that D.S. reportedly hosted. The psychiatrist who treated D.S. could find no evidence of such a show.

[26] While hospitalized, D.S. claimed to have written comprehensive mental health legislation for the nation in three hours. Id. at 21-22. D.S. denied he was mentally ill and refused all medications, although he displayed euphoria, rapid and pressured speech, decreased need for sleep, multiple delusions, agitation, and racing thoughts while hospitalized. Id. at 19. In fact, he displayed “paranoia about medications” as well as suspicion of doctors and the legal system. Id. at 20. D.S. specifically referred to lithium as a “Nazi drug,” although the psychiatrist testified it had been successfully used in treatment of mental illness. Id. at 31.

[27] Because D.S. made clear that he would refuse treatment and medications for his mental illness, D.S.’s treating psychiatrist testified that, absent involuntary commitment, D.S. would continue to experience manic episodes that would put him at risk of bodily harm. Individuals with mania also have a high risk of suicide, according to the psychiatrist.

[28] The psychiatrist further testified that “people with mania ․ put themselves in risky situations, become intrusive with other people ․ and they'll get into other people's business.” Id. at 31. He noted that D.S. had exhibited such behavior while hospitalized. For instance, D.S. instructed other patients to refuse their medications, advised them that they should not be hospitalized, and sought to contact their families by telephone. The psychiatrist opined that if D.S. engaged in such behavior outside the structured hospital environment, “he could end up in a very risky situation because of it.” Id. at 31-32. This particular evidence, in turn, suggests that D.S.’s pattern of sending hostile videos might expose him to harm.

[29] After noting D.S.’s “tangential like speech and thinking, pressured speech and ․ multiple delusions,” the psychiatrist concluded that D.S. “suffer[s] substantial impairment or obvious deterioration of his judgement and reasoning or behavior, that results in an ability to function independently.” Id. at 20. Given the psychiatrist's testimony, the broader evidence of D.S.’s significant delusions, and the potential for harm to D.S. that those delusions generate, we conclude that clear and convincing evidence supports the trial court's finding that D.S. was gravely disabled.

[30] We affirm the trial court's judgment.

FOOTNOTES

1.   D.S. revealed greater details of the federal RICO (Racketeer Influenced and Corrupt Organizations Act) litigation that he allegedly was developing. He claimed that the litigation involved 2,800 people and that he had been “building” it for 15 years, apparently in connection with his purported work as a confidential informant for homeland security. Tr. Vol. II, p. 37. D.S. was employed as a health care provider during this time.

2.   Given our finding that this appeal is not moot, we need not address D.S.’s claims that this case falls within the public-interest exception to the mootness doctrine.

3.   D.S. testified that he refused blood pressure medicine due to his preference for natural remedies and his belief that his blood pressure had spiked only temporarily due to the salt in his hospital food. As the trial court based its decision on more than the blood pressure evidence, we need not decide whether D.S.’s refusal to take blood pressure medicine alone was sufficient to justify the trial court's finding that he was gravely disabled.

Weissmann, Judge.

Judges Pyle and Felix concur. Pyle, J., and Felix, J., concur.