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

MEMORANDUM DECISION

[1] B.D. appeals the trial court's order granting Richmond State Hospital's (“the Hospital”) petition for involuntary regular commitment of B.D. She argues that the trial court erred in ordering her regular commitment because there was insufficient evidence presented to prove that she is dangerous and gravely disabled. We affirm.

Facts and Procedural History

[2] B.D. was initially admitted to the Hospital on July 10, 2024.¹ She was forty-five years old at the time and had been previously diagnosed with schizophrenia, “seizure disorder secondary to head trauma,” and an “unspecified intellectual impairment.” Tr. Vol. II p. 15. When B.D. was nine years old, she suffered a traumatic brain injury, which caused her to be in a coma “for quite a while.” Id. As a result of her head trauma, B.D. had significant frontal temporal lobe damage. After her admission, B.D. was diagnosed with orbitofrontal neurocognitive disorder and intermittent explosive disorder, secondary to head trauma.

[3] After B.D.’s admission, Jasmine Newton (“Newton”), who serves as the Hospital's psychiatric services specialist, saw B.D. almost every weekday. When Newton observed B.D. in meetings, B.D. had frequent outbursts and had to be “re-directed from interrupting or detracting” from the group sessions. Id. at 35. Newton also observed that B.D. would become emotional very quickly and would often cry or yell at staff or peers in the unit, seemingly without any reason. B.D. mentioned thoughts of self-harm and also complained about her medication to Newton.

[4] On October 17, 2024, psychiatrist Dr. Oleh Dzera (“Dr. Dzera”) began treating B.D. When he first met with B.D., Dr. Dzera observed that she was agitated and “very angry, very irritable.” Id. at 9. Because she had a “tendency toward agitation,” B.D. was on a restriction at that time that required her to be accompanied by precaution staff, who were assigned to her to ensure that she did not “hurt herself or anyone else” at all times. Id. at 9, 13. This restriction remained in place through the date of B.D.’s commitment hearing. B.D. was also placed on chair restrictions after several episodes of agitation. Chair restrictions, during which a patient is placed in a chair and is “tied down,” are used for a limited time when a patient is agitated and may present danger to themselves or others, and de-escalation measures such as talking to the patient or “as needed medication” fail at calming the patient. Id. at 12.

[5] On January 9, 2025, the Hospital filed a petition for B.D.’s involuntary regular commitment, and a remote hearing was held on February 18, 2025. At the commitment hearing, Dr. Dzera explained that significant frontal lobe damage, like what B.D. has, can affect an individual in many ways such as causing extreme mood swings, bouts of verbal and physical aggression, a lack of empathy, and “a lack of understanding for what their behavior might entail to other people.” Id. at 19. Dr. Dzera explained that B.D.’s mood swings were “completely exaggerated” from the “normal sphere” and her aggression can be directed at others or herself. Id. As a result of her diagnoses, Dr. Dzera prescribed B.D. medications to regulate her behavior, her mood, her anxiety, and her agitation and to assist in her lack of control over her behavior secondary to her other medical conditions. B.D. generally needed convincing by the staff to take her medications and always argued with them about taking the medications. Dr. Dzera testified that, because of her mental illness, B.D. would oscillate back and forth between compliance with her medications and refusal to take her medications.

[6] Dr. Dzera also testified that as a result of the physiological condition of her frontal temporal lobe damage, B.D. had developed an unspecified personality and behavioral disorder. This disorder often presented as extremely poor frustration tolerance and as misunderstanding situations with others. Dr. Dzera stated that he believed that due to her aggressiveness, B.D. may pose a danger to others and that based on her comments about feeling hopeless and worthless, she could be a danger to herself. Dr. Dzera also stated that he did not believe that, outside of the “structured environment[ ]” of a hospital setting, B.D. would be able to take care of her basic needs. Id. at 23. He did not believe she had the ability to secure her own food, clothing, or shelter and would have a difficult time securing employment and managing financial responsibilities. Dr. Dzera personally observed the staff bathing B.D., and he testified that B.D. had issues regulating her bodily functions as she had urinated on herself and defecated on the floor on several occasions. Newton also testified that she had observed the staff bathing B.D. and assisting her in using the bathroom and with getting dressed and changing out of her clothing.

[7] Dr. Dzera testified that the best treatment plan for B.D. required addressing her neurological cognitive deficits in addition to administering medications. He hoped to regulate her agitation and aggressiveness so that she could be transferred to an inpatient unit where they specialize with people who have similar brain injury issues that could provide more intensive treatment. Dr. Dzera opined that currently the least restrictive environment for B.D.’s care was the Hospital but was hopeful that after receiving treatment she could transition to the inpatient facility specializing in brain injury patients.

[8] B.D. testified that she disagreed with Dr. Dzera's diagnoses and stated that “[t]hey think [she is] seriously ill but [she's] not.” Id. at 51. She stated that she was not depressed but rather had situational sadness. She claimed that she needed to be taken off the Ativan and Haldol because they were “breaking down [her] bones” and making her “very, very tired.” Id. at 50. She also requested to be taken off the requirement of having precaution staff accompany her everywhere. When asked about regulating her bodily functions, B.D. confirmed the issues that had occurred and stated that she had defecated in the corner of her room because the staff would not let her out of the room and she had urinated on herself because she was very mad because they took forever to get to her.

[9] When asked about her plans if she were to be released from the Hospital, B.D. testified that she would go live with her father, then go to Champaign, Illinois, and eventually California to start her own company “to take over places like [the Hospital] for people like us[.]” Id. at 55. She also engaged in disorganized testimony about her past and her future plans if released. During final arguments, B.D. interrupted the Hospital's attorney when he mentioned her defecation issue to state that she defecated on a wall because she had been locked in her room and had been traumatized by her father.

[10] At the conclusion of the hearing, the trial court found by clear and convincing evidence that B.D. was “suffering from frontal temporal neurocognitive disorder, disinhibited pseudo psychopathy syndrome, [and intermittent] explosive disorder[,] which are mental illnesses.” Id. at 60. The trial court further found that B.D. was a danger to herself and was gravely disabled and that she was in need of care, custody, and treatment at the Hospital. The trial court found Dr. Dzera to be a “highly credible witness” and granted the Hospital's petition for the involuntary regular commitment of B.D. Id. at 61. The trial court reached its conclusion by considering B.D.’s “aggressive, agitated” behaviors; the need for medications, occasional chair restrictions, and consistent accompaniment of precaution staff to control these behaviors; a lack of empathy and understanding of her behavior; and the need for “structure and supervision” to take medication and meet her basic needs. Id. The trial court also found that B.D. lacked a realistic plan for her care after her release and lacked insight into her condition. B.D. now appeals.

Discussion and Decision

[11] B.D. challenges the sufficiency of the evidence supporting the trial court's finding that she was dangerous and gravely disabled. Pursuant to Indiana Code section 12-26-2-5(e), there must be clear and convincing evidence supporting the trial court's findings. When reviewing the sufficiency of the evidence in civil commitment cases, we “will affirm if, ‘considering only the probative evidence and the reasonable inferences supporting [the statutory findings], 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 Affs., 27 N.E.3d 271, 273 (Ind. 2015) (second alteration in original) (quoting Bud Wolf Chevrolet, Inc. v. Robertson, 519 N.E.2d 135, 137 (Ind. 1988)). Clear and convincing evidence requires proof that “the existence of a fact ․ [is] highly probable.” T.D. v. Eskenazi Health Midtown Cmty. Mental Health Ctr., 40 N.E.3d 507, 510 (Ind. Ct. App. 2015).

[12] To enter a civil commitment order, the trial court must find that “the individual is mentally ill and either dangerous or gravely disabled[.]” Ind. Code § 12-26-2-5(e) (emphasis added). Here, B.D. does not dispute that she suffers from mental illness. Rather, she argues the evidence was insufficient to establish that she was dangerous or gravely disabled.

[13] Indiana Code section 12-26-2-5(e) is written in the disjunctive, such that if we affirm on either dangerousness or grave disability, we do not need to address the alternate element. Therefore, we proceed to determine whether sufficient evidence supported the trial court's finding that B.D. was gravely disabled. Indiana Code section 12-7-2-96 defines “gravely disabled” 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.

[14] B.D. argues that the evidence presented was insufficient to support that she was gravely disabled, pointing out that, prior to her hospitalization, she was able to do her own shopping, pick up her own medication, and administer those medications. B.D. also pointed out that, at the time of the hearing, she was able to bathe herself in the Hospital. She also asserts that the opinions of Dr. Dzera and Newton were not sufficient to meet the Hospital's burden because they lacked evidentiary support. B.D. also contends that the evidence of the instances of her urination and defecation issues were not sufficient to establish her inability to function independently because the issues only occurred due to “her lack of access to a restroom, rather than her mental illness.” Appellant's Br. p. 12.

[15] B.D.’s assertions are merely requests to reweigh the evidence, which we will not do. T.K., 27 N.E.3d at 273. Although B.D. highlights tasks she was able to perform prior to her hospitalization, the evidence at the hearing revealed that B.D. had no insight into her mental illness and was unable to manage her basic needs as a result of her mental illness. There was testimony that, as result of B.D.’s frontal temporal lobe damage, she had developed an unspecified personality and behavioral disorder, which resulted in poor frustration tolerance and misunderstanding situations with others. Dr. Dzera testified that due to her aggressiveness, B.D. could pose a danger to others and that based on her comments about feeling hopeless and worthless, she could be a danger to herself. B.D. required constant supervision by the Hospital staff and was required to be always escorted by precaution staff to ensure that she did not “hurt herself or anyone else” because she had a “tendency toward agitation.” Tr. Vol. II pp. 9, 13. B.D. had frequent outbursts and would become emotional very quickly, would often cry or yell at others in the unit without any reason, had bouts of verbal and physical aggression, a lack of empathy, and discussed thoughts of self-harm. B.D.’s supervision restriction remained in place for the majority of the time that she was hospitalized and was still in place at the time of the hearing for involuntary commitment. Due to her outbursts, agitation, and possibility of danger to herself and others, B.D. was also placed on chair restrictions when de-escalation measures such as talking to her or medication failed to calm her. B.D. was prescribed multiple medications to regulate her behavior, mood, anxiety, and agitation and to assist in her lack of control over her behavior, but she generally needed convincing to take her medications and always argued with the staff about doing so, which Dr. Dzera testified was due to her mental illness.

[16] Dr. Dzera also stated that he believed that B.D. would not be able to care for herself outside of the structured environment of a hospital setting because she would not be able to secure her own food, clothing, or shelter and would have a difficult time securing employment and managing financial responsibilities.² Both Dr. Dzera and Newton testified that they had observed the staff bathing B.D. and assisting her in getting dressed, and evidence was presented that B.D. had issues regulating her bodily functions on several occasions. Further, although B.D. testified regarding her plans for if she were to be released from the Hospital, such testimony was disorganized and did not set out a concrete and realistic plan.

[17] We, therefore, conclude that clear and convincing evidence was presented to establish that, as a result of her mental illness, B.D. was unable to provide for her food, clothing, shelter, or other essential human needs and was unable to function independently. In light of the evidence most favorable to the judgment, we conclude that sufficient evidence supported the trial court's findings that B.D. was mentally ill and gravely disabled under Indiana Code section 12-26-2-5(e) and the trial court's order granting the Hospital's petition for involuntary regular commitment.

[18] Affirmed.

FOOTNOTES

1.   The record is silent as to the circumstances of B.D.’s initial admission to the Hospital.

2.   The record is otherwise silent as to B.D.’s financial circumstances and employment status prior to her admission to the Hospital.

Foley, Judge.

Judges Kenworthy and Scheele concur. Kenworthy, J. and Scheele, J., concur.