Commitment of G.J., Appellant-Respondent v. Sandra Eskenazi Mental Health Center, Appellee-Petitioner (2025)

MEMORANDUM DECISION

Case Summary

[1] G.J. appeals the trial court's order continuing her regular commitment to outpatient care at Health & Hospital Corporation of Marion County d/b/a Sandra Eskenazi Mental Health Center (Eskenazi) for a period of time expected to exceed ninety days. G.J. raises one issue, which we restate as whether there was sufficient evidence to support the court's determination that she was gravely disabled at the time of her commitment hearing. We affirm.

Facts and Procedural History

[2] On May 16, 2023, IU Health Methodist Hospital (IU Health) filed a petition for the temporary involuntary commitment of G.J., a twenty-three-year-old woman, after she was hospitalized for symptoms of catatonia. This petition was accompanied by a physician's statement which specifically requested treatment in an inpatient psychiatric unit. After a hearing, the court found G.J. to be gravely disabled and ordered that she be temporarily committed at IU Health until August 22. G.J. was subsequently transferred from IU Health to Eskenazi. Her treatment plan listed her long-term goal as “[r]eturn[ing] to level of functioning.” Appellant's Appendix Vol. 2 at 49.

[3] On July 25, Eskenazi requested an extension of G.J.’s temporary commitment, on grounds that she was “gravely disabled and in need of continuing custody, care or treatment in an appropriate facility[.]” Id. at 56. The accompanying physician's statement explained that G.J. suffers from “schizophrenia with [a] history of catatonia[,]” “does not believe she needs medication[,]” and that “without medication she would develop psychosis again, potentially catatonia, and not be able to perform [activities of daily living].” Id. at 57-58. After a hearing, the trial court found G.J. to be gravely disabled and extended her temporary commitment to November 13.

[4] On October 17, Eskenazi requested a continuation of G.J.’s temporary commitment, claiming she was gravely disabled and continued to suffer from “schizophrenia with [a] history of catatonia, depression, [and] anxiety[,]” but the physician's report recommended switching G.J. to regular outpatient commitment. Id. at 84-85. After a hearing, the trial court found G.J. to be gravely disabled and ordered that she be placed on a regular outpatient commitment. The order noted that G.J. “only eats, drinks, takes med[ication], and bathes with strong prompting. She has been hospitalized [ten] times in [three] years.” Id. at 101. The order also required G.J.’s attending physician to submit a Periodic Report on G.J.’s condition and treatment plan no later than October 25, 2024.

[5] On October 4, 2024, based on the Periodic Report, the trial court continued G.J.’s regular commitment without a hearing but granted G.J.’s subsequent motion for a review hearing. At the hearing on November 25, Dr. Carla Arellano, G.J.’s outpatient psychiatrist since June 2023, testified in support of continuing G.J.’s commitment. G.J. and her mother testified against continuing the commitment.¹ Dr. Arellano explained that “since November of 2020 [G.J.] has been hospitalized ten times due to psychosis [ ] and noncompliance with medication[,]” adding that,

the most recent hospitalization ․ she was in the hospital for a couple of months and required treatment with ECT  2 [ ] because medication was not working well enough and so in her case it seems like [ ] with repeated episodes of psychosis it's become harder and harder to treat her symptoms.

Transcript at 12. The record shows that, in addition to ten hospitalizations, G.J. had eight mental health cases filed in the four years preceding the November 25 hearing.

[6] When asked by the court what she believed would happen if G.J. stopped taking her medication, Dr. Arellano testified that G.J.’s psychosis would get worse and that she could develop catatonia again. Dr. Arellano explained that G.J.’s catatonia manifested as an “almost [statue-]like kind of freezing, she doesn't eat, and she doesn't sleep[,]” and that the health risks associated with catatonia include severe malnutrition and injury to the kidney(s). Tr. at 13. It was Dr. Arellano's opinion that G.J. would be in danger of harm if her regular commitment ended because even the month before her hearing, G.J. had stated that she did not need treatment. See Tr. at 16.

[7] G.J. testified that despite her diagnosis, she cooks, cleans, drives, puts gas in her car, goes grocery shopping, pays her bills, eats, sleeps, and tends to her own hygiene. However, she discussed how she noticed a month before her hearing that “[n]othing” happened when she stopped taking her medication. Id. at 40. G.J. admitted that she had stopped taking her medication in the past when she was not under a court order to do so and said that she “didn't necessarily see the reason to take [her] medication.” Id. at 41. She recently realized she needed to “grow up a little bit” and testified that she would continue to take her medication if her commitment ended. Id. at 41, 43.

[8] Noting G.J.’s ten hospitalizations and eight mental health cases—the latter of which increased in frequency in 2022 and 2023—the trial court granted Eskenazi's motion to continue G.J.’s regular commitment. See id. at 48-49. The trial court determined that the record reflected an “abundantly clear” pattern in which G.J. stops taking her medication when she doesn't believe she needs it, and that this pattern results in both grave disability and “unsafe conduct involving her hospitalization inevitably.” Id. at 49. This appeal ensued.

Discussion and Decision

[9] G.J. contends there was insufficient evidence to show by clear and convincing evidence that she was gravely disabled, a prerequisite to continuing her regular commitment. Our review of a sufficiency challenge in a civil commitment case requires us to “consider only the probative evidence and reasonable inferences supporting it, without weighing evidence or assessing witness credibility.” A.O. v. Comty. Health Network, Inc., 206 N.E.3d 1191, 1193 (Ind. Ct. App. 2023). If there is clear and convincing evidence supporting the trial court's decision, we will affirm. Id. “Clear and convincing evidence requires proof that the existence of a fact is ‘highly probable.’ ” F.L. v. Comty. Fairbanks Behav. Health, 245 N.E.3d 1033, 1035 (Ind. Ct. App. 2024) (quoting Matter of Commitment of C.N., 116 N.E.3d 544, 547 (Ind. Ct. App. 2019)), trans denied.

[10] G.J. concedes that she has a mental illness and only challenges the trial court's determination that she is gravely disabled. Involuntary commitment of a mentally ill individual is permitted when it is proven by clear and convincing evidence that: (1) the individual is either dangerous or gravely disabled; and (2) detention or commitment is appropriate. Ind. Code § 12-26-2-5(e). Because the statute is written in the disjunctive, Eskenazi only had to prove that G.J. was either dangerous or gravely disabled, not both. A.O., 206 N.E.3d at 1193. Here, the trial court found that Eskenazi sufficiently proved that G.J. was gravely disabled. See Tr. at 50.

[11] “Gravely disabled” is defined as:

[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.

I.C. § 12-7-2-96. At the hearing, Eskenazi focused on subpart (2), arguing that G.J.’s judgment, reasoning, or behavior is substantially impaired resulting in her inability to function independently. See Tr. at 16.

[12] G.J. asserts that “[t]he uncontradicted evidence demonstrated that [she] was functioning independently” and that the trial court “made no explicit finding that [her] judgment and reasoning resulted in her inability to function independently[.]” Appellant's Br. at 12. She contends that the court's decision was only based on her lack of insight into her illness and resistance to taking her medication, which was not enough. Id. at 11; see Civil Commitment of T.K. v. Dep't of Veterans Affs., 27 N.E.3d 271, 276 (Ind. 2015) (“[D]enial 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.’ Ind. Code § 12-7-2-96(2).”). She directs us to Commitment of M.E. v. Dep't of Veterans Affs., where our Court found insufficient evidence of grave disability because the government failed to prove that the patient's denial of his mental illness and refusal to medicate “made him unable to function independently.” 64 N.E.3d 855, 863 (Ind. Ct. App. 2016). The court also found M.E.’s aggression and paranoia that resulted from his failure to medicate were equally insufficient to show a failure to function independently. Id. We find M.E. distinguishable from G.J.’s case.

[13] Here, G.J.’s refusal of medication and lack of insight into her illness were not the only evidence presented at the hearing. The evidence admitted indicated that her refusal to medicate resulted in more than aggression or paranoia—G.J. became catatonic, which left her unable to function independently. G.J.’s doctor testified that as a result of her most recent psychotic episode, her catatonia left her hardly able to move, eat, or sleep. Further, if untreated, catatonia can lead to malnutrition, muscle breakdown, and kidney injury. We also note that G.J.’s catatonia and the harm caused by catatonia is not speculative because it happened to G.J. before. The last time she was off her medications, G.J. developed catatonia and was in the hospital for several months. Lastly, her doctor testified that G.J.’s psychosis has gotten progressively worse and harder to treat each time she stopped taking medication, the most recent episode requiring ECT because medication would not break her psychosis.

[14] G.J. directs us to her testimony when she told the court she had been taking her medication on her own and would continue to do so once the commitment ended. Id. at 35, 39. She testified that in the few weeks before the commitment hearing, she realized she needed to “grow up a little bit” and take her medication. Id. at 43. She also testified that she has a monthly income, a place to live, family support, and that she pays her bills and manages her affairs. However, G.J. is asking us to prioritize her testimony over the evidence that she had a pattern of refusing to take medication as ordered and her doctor's testimony that G.J. said she would not take her medication without a commitment order. Her request is asking us to reweigh the evidence and judge witness credibility, which we will not do.

[15] “Where the evidence is in conflict, we are bound to view only that evidence that is most favorable to the trial court's judgment.” Golub v. Giles, 814 N.E.2d 1034, 1038 (Ind. Ct. App. 2004), trans. denied. Viewing the evidence most favorable to the trial court, we find that G.J. has had ten hospitalizations over the past four years, a pattern of refusing to take medication when not under a commitment order, and the risk of developing catatonia and even greater resistance to effective psychosis treatments. We conclude this evidence clearly and convincingly supports the trial court's finding that G.J. was gravely disabled. See E.F. v. St. Vincent Hosp. & Health Care Ctr., 194 N.E.3d 1130, 1138 (Ind. Ct. App. 2022) (finding patient's grave disability proven in part by a “history of not taking her medications” and the likelihood of future harm if patient ceased “taking all of her medications”).

Conclusion

[16] Finding there was clear and convincing evidence of G.J.’s grave disability, we affirm.

[17] Affirmed.

FOOTNOTES

1.   G.J.’s brother and father were also set to testify against continuing her commitment, but in the interest of time and considering their testimony was substantially the same as Mother's, only Mother testified. See Transcript at 44-45.

2.   “ECT” stands for “electroconvulsive therapy.”

DeBoer, Judge.

Chief Judge Altice and Judge Pyle concur. Altice, C.J., and Pyle, J., concur.