IN RE: the Civil Commitment of: E.R. (2026)

MEMORANDUM DECISION

[1] This is an expedited appeal of the trial court's order temporarily committing E.R. to Richard L. Roudebush Veterans Affairs Medical Center (“the VA”). As the VA does not participate on appeal, we restate the issue as whether E.R. identified prima facie error in the determination that he is gravely disabled. Identifying prima facie error, we reverse the temporary commitment order.

Facts and Procedural History

[2] E.R. was admitted to the VA on June 25, 2026. The VA petitioned for E.R.’s temporary commitment, and the trial court held a commitment hearing on July 9, 2026. The VA's sole witness was Dr. Jacob Knight (“Dr. Knight”), a “second-year psychiatry, peds[,] and child psychiatry resident at IU,” who started practicing at the VA on July 1, 2026. Tr. p. 4. Dr. Knight was on rotation as the primary physician for the “inpatient locked psychiatric unit” and had treated E.R. for the past nine days. Id. Dr. Knight's supervising physician was Dr. Yana Choi, who agreed with his diagnosis as to E.R. Over E.R.’s objection, the trial court qualified Dr. Knight as an expert in psychiatry.

[3] E.R. was a seventy-two-year-old Army veteran who was first diagnosed with bipolar I disorder in April 2023. This was his second time being admitted to the VA in June 2026, with his last admission taking place from June 14 to June 22. E.R. recounted that, in 2020, he spent approximately eighty-four days at the Logansport State Hospital for a competency evaluation. E.R. reported that, as a result of that hospital stay, he was found “100 percent sane to stand trial” and “100 percent capable of representing [himself] in [a] court of law.” Id. at 47.

[4] Dr. Knight said that E.R.’s current commitment stemmed from an incident where E.R.’s vehicle collided with a wall at the VA. He spoke with E.R. about his understanding of the circumstances of his admission. In speaking with Dr. Knight, E.R. described being at the hospital to get medicine from the pharmacy when “police officers kicked him out of the hospital and forced him to drive away in his car.” Id. at 10. E.R. told Dr. Knight that “[h]e was in his car and ran into a wall, and that is where the police officers then found him again and brought him to the VA emergency room for further evaluation.” Id.

[5] At the hearing, E.R. attributed the vehicle collision to a “neurological event”—“not a psychological event, but a neurological event to where my brain was clouded and everything.” Id. at 42. E.R. testified that he was under the care of a VA neurologist, who prescribed him medication that he was picking up before the collision. E.R. said that, “rather than treat[ ] it as an auto accident, which would've put me over at Eskenazi as an ambulatory patient,” they “went ahead and assumed that [he] needed to come back up to psychology, which is a totally false thing because it was a neurological event and [he] hit the wall.” Id. E.R. thought the wall was “less than a meter away,” resulting in minimal damage, such as a “dent” in the wall. Id. Dr. Knight testified that after “neurological monitoring via physical exam and observation,” he had no evidence that E.R. suffered a neurological event with no indication for further workup. Id. at 31.

[6] The VA elicited testimony from E.R. about an incident at a gas station a day or so before his admission. E.R. testified that he called for an ambulance after a disagreement with a woman regarding a political shirt he was wearing, stating:

I realized that I was getting over agitated and I started to leave and as I did, I realize that there was something wrong. So rather than try to drive, I went ahead and called an ambulance because I felt like that it was something past when I would normally just sit there and wait it out. This was a new neurological event that I had not witnessed before.

Id. at 53.

[7] Dr. Knight diagnosed E.R. with bipolar I disorder with an acute manic episode based on E.R. exhibiting thoughts of grandiosity, decreased need for sleep, pressured speech, flight of ideas, and “some increase in goal-directed activity.” Id. at 12. As to thoughts of grandiosity, Dr. Knight testified that E.R. had claimed: a role in the political campaigns of the Governor and the President, service as an advisor, development of the USB port and income from it amounting to twenty-five percent of $14 billion, and land holdings in Carmel. E.R. testified that he was active in Republican Party fundraising and did not personally know the President but “know[s] of the President as per getting cards from him and different things that he congratulates us for working together.” Id. at 44. E.R. said that he holds a patent from his work with Intel, having worked as a computer and software design engineer “since [he] got a double from Purdue.” Id. at 45. Dr. Knight did not seek to verify any of E.R.’s claims.

[8] As to sleep, Dr. Knight testified that E.R. reported needing four hours of sleep at a time and averaged four to five hours a night while on the unit. E.R. said that he slept about three and a half hours the night before the hearing, which was less than usual, noting: “Usually it takes me about four and a half hours.” Id. at 53. Dr. Knight was asked if, as a resident, he ever existed on less than four hours of sleep. He responded: “Existed? Yes. Function? No.” Id. at 39.

[9] Dr. Knight further testified that E.R. denied suffering from an acute manic episode and “denied any problems associated with the symptoms he has been experiencing due to his mental health condition.” Id. at 14. He said E.R. refused medication in favor of yoga, meditation, hot tubs, and playing with his dogs, and he was non-compliant with medication protocols during his admission to the VA earlier that same month. When E.R. was asked if he agreed with the diagnosis that he suffered from bipolar disorder, he replied:

I don't disagree, but I maintain that I have my own psychiatrist that I hire personally, and that psychiatrist likes to use transcendent [sic] meditation. He likes to use yoga, he likes to use Pilates, and different things that help me go. I'm 72, and I still run seven miles every day, and I bench 220. Now tell me if you [sic] like to reach that accomplishment.

Id. at 46. E.R. explained his rationale for declining medication in favor of alternative approaches, stating: “Because I'm maintaining otherwise.” Id. at 47.

[10] Dr. Knight did not believe that E.R. could manage his income appropriately because E.R. had “consistently given [him] different accounts of his finances, as well as where his finances are located, as well as his assets.” Id. at 17. Dr. Knight stated: “And given that there is, as well as [sic] not being able to disclose or participate in discussions around those consistently, concerns me [sic].” Id.

[11] When Dr. Knight was asked if he “believe[d] that [E.R.] is at risk of coming to some harm to himself,” he said, “Yes.” Id. at 15. The basis for this belief was that E.R. “did tell [him] that he crashed into the VA wall” and “allude[d] to that being related to a medical condition.” Id. at 16. He added: “Additionally, during our encounters he has had [a] difficult time discussing any potential aftercare treatment for his mental health condition. He has difficult times reporting to me safety planning, and so because of that I do have concerns for his safety.” Id. Dr. Knight stated that due to E.R.’s paranoia and overall symptoms of being in a manic episode, he “worr[ied] about him functioning independently.” Id. at 17.

[12] Dr. Knight opined that, if E.R. were to be discharged without medication, he remained at risk for another vehicle collision, stating: “Due to his current mental state, he is unable to sleep the appropriate amount that he would need in order to function safely. He has increased goal-directed activity that may lead him to continue to participate in actions that may lead him to be unsafe.” Id. at 16. Dr. Knight explained that continued manic episodes “have demonstrated that there is a lifetime risk of increased suicidality up to 15 times that of the general population. Additionally, individuals in acute manic states have significantly more interactions with law enforcement, with activities that could lead to self-harm to themselves or others, and so, yeah.” Id. at 18. He acknowledged that, earlier that month, E.R. was discharged despite medication non-compliance because “[t]he decision made by the previous psychiatrist was at that time [E.R.] was safe to discharge.” Id. at 32.

[13] Dr. Knight opined that E.R. suffered from a substantial impairment in his reasoning as a result of an acute manic episode, reasoning as follows:

Due to their thoughts of grandiosity and tangentiality, their ability to focus and engage meaningfully with others is limited, and because of that, individuals in manic episodes have a difficult time maintaining appropriate relationships and boundaries with many individuals in their lives, including police officers, including family members, including members of the community.

Id. at 18. Dr. Knight recommended that E.R. be temporarily committed for the administration of medication that would “reduce the potential adverse outcomes of [E.R.] remaining in an acute manic episode.” Id. at 20.

[14] E.R. testified that he lives at his sister's home, which had been his address of record for the preceding two and a half years. He said that he receives Social Security and other income and manages his own finances. E.R. further testified that he shops for himself, cooks for himself, and manages his own hygiene. Dr. Knight agreed that E.R. was eating well and at a normal weight. However, he described E.R.’s hygiene as inconsistent. When asked to clarify his testimony, Dr. Knight stated: “For instance, [E.R.] had told me he showered this morning getting ready for the hearing. When I spoke with him, he had food remnants still in his beard, as well as his shirt was buttoned incorrectly.” Id. at 33.

[15] At the close of evidence, the VA asserted that a temporary commitment was warranted because E.R. was mentally ill “and either a danger to self or others or gravely disabled ․” Id. at 59. Although the VA referred to dangerousness, its argument largely focused on whether E.R. was gravely disabled because he was unable to function independently. It presented the following argument:

Given that he has no insight into his diagnosed mental illness and has expressed and stated intent to not utilize medication in order to treat that illness, and given the doctor's testimony that in the absence of a treatment regimen that includes medication, that he will continue to exhibit these symptoms and remain unable to function independently[,] ․ [the VA] respectfully requests that the temporary commitment in this case be granted.”

Id. at 60. E.R. argued that the VA failed to present clear and convincing evidence that his “judgment and reasoning is so impaired that he can't function independently.” Id. at 61. Thereafter, the trial court took judicial notice of a 2023 temporary commitment order entered under cause number 49D08-2304-MH-016165 in which the court had found E.R. gravely disabled “in his judgment and reasoning by delusions of wealth and influence.” Id. at 62.

[16] The trial court did not find that a temporary commitment was warranted based on dangerousness. Rather, the trial court entered an order finding, by clear and convincing evidence, that E.R. suffers from bipolar disorder and is gravely disabled, citing his denial of illness, refusal to medicate, grandiosity, lack of sleep, history of medication non-compliance, the prior stay at Logansport State Hospital, the prior commitment, and the vehicle collision. The court ordered E.R. committed to the VA for a period not to exceed ninety days. E.R. then pursued this expedited appeal pursuant to procedures our Supreme Court set forth in the Marion County Expedited Mental Health Appeals Pilot Project.

Discussion and Decision

[17] E.R. challenges the finding that he was “gravely disabled” as defined in Indiana Code section 12-7-2.1-170.¹ 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).

[18] Because the VA has not filed a Brief of Appellee, we may reverse on a showing of prima facie error, which means error at first sight, on first appearance, or on the face of it. Ind. Appellate Rule 45(D); Front Row Motors, LLC v. Jones, 5 N.E.3d 753, 758 (Ind. 2014). This less-stringent standard applies because our role is not to “controvert[ ] arguments advanced for reversal, a duty which properly rests upon counsel” for the Appellee. McBride v. Cox, 567 N.E.2d 130, 134 (Ind. Ct. App. 1991), trans. denied; Front Row Motors, 5 N.E.3d at 758 (explaining that we need not undertake the burden of developing arguments). While this rule relieves us of the burden of constructing the Appellee's arguments for affirmance, it does not lessen the deference we otherwise owe the trial court's findings under the sufficiency standard set out above.

[19] 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). Here, the trial court found that E.R. was mentally ill and gravely disabled. E.R. does not dispute that he suffers from mental illness. Rather, he argues the evidence was insufficient to establish that he was gravely disabled. Indiana Code section 12-7-2.1-170 defines “gravely disabled” as follows:

“Gravely disabled”, for purposes of IC 12-26, 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;

(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; or

(3) lacks a fixed, regular, and adequate shelter, resulting in the individual remaining outdoors in places not designed for or ordinarily used for sleeping during weather conditions that are likely to result in death or serious physical injury, if:

(A) the individual has refused transportation to a shelter or mental health service provider; and

(B) a shelter or mental health service provider was reasonably offered and available.

[20] E.R. focuses his argument on subsection (2), which we agree is the germane subsection. To support a finding that a person is gravely disabled under this subsection, there must be clear and convincing evidence that, as a result of mental illness, E.R. is in danger of coming to harm because he has a substantial impairment or an obvious deterioration of his judgment, reasoning, or behavior that results in his inability to function independently. See I.C. § 12-7-2.1-170.

[21] Standing alone, a person's denial of illness and refusal to medicate are insufficient to establish grave disability; these circumstances do not establish that individual is in danger of coming to harm and unable to function as a result. See generally T.K., 27 N.E.3d at 276. Furthermore, “loss of liberty calls for a showing that the individual suffers from something more serious than is demonstrated by idiosyncratic behavior.” T.D., 40 N.E.3d at 511 (quoting Commitment of G.M., 743 N.E.2d 1148, 1151 (Ind. Ct. App. 2001)).

[22] In finding E.R. gravely disabled, the trial court stated that it “consider[ed] the evidence collectively” and based its determination on, “including but not limited to, denial of illness, refusal to medicate, grandiosity, lack of sleep, history of noncompliance with medication, prior stay at [L]ogansport [S]tate [H]ospital, temporary commitment granted [in a different cause,] and ran a car into the VA wall.” Appellant's App. Vol. II p. 7. E.R. argues that the VA failed to establish by clear and convincing evidence that he was unable to function independently based on his constellation of symptoms. We conclude that E.R. identified prima facie error in the evidentiary support for the order.

[23] The shape of the VA's case explains the error. In closing, the VA argued that E.R. was both gravely disabled and “a danger to himself,” pointing to the vehicle collision and the recent disagreement at a gas station. Tr. pp. 59–60. However, the trial court did not adopt the theory that E.R. was dangerous. See I.C. § 12-26-2-5(e) (requiring a finding that the individual is mentally ill and “either dangerous or gravely disabled”). Rather, the trial court found that E.R. was mentally ill and gravely disabled. Grave disability requires proof of more than a danger of coming to harm. The VA had to establish that the danger flowed from a substantial impairment or an obvious deterioration of E.R.’s judgment, reasoning, or behavior that “result[ed] in [his] inability to function independently.” I.C. § 12-7-2.1-170(2). The accident risk, the suicidality figures, the prospect of police contact, and Dr. Knight's inability to engage E.R. in safety planning bear on the first of that showing. None supplies the second.

[24] Even if we were to infer from Dr. Knight's testimony that it was dangerous for E.R. to operate a vehicle, the record does not establish, as a matter of law, that operating a vehicle is integral to E.R.’s ability to function independently. The evidence of its cause came from E.R. himself, who reported to Dr. Knight that he “crashed into the VA wall ․” Tr. p. 16. Dr. Knight said that E.R. “allude[d] to that [collision] being related to a medical condition,” but the VA did not connect that account to any specific failure in E.R.’s daily functioning. Id. At one point, Dr. Knight testified that E.R. was at risk of another collision if discharged without medication because his mental state left him “unable to sleep the appropriate amount that he would need in order to function safely” and produced “increased goal-directed activity that may lead him to continue to participate in actions that may lead him to be unsafe.” Id. Notably, however, Dr. Knight described the same sleep symptom in seemingly incompatible ways—as a “decreased need for sleep” when listing diagnostic criteria, id. at 12 (emphasis added), and as an inability to obtain enough sleep to function safely when asked about the risk of another accident, id. at 16. The VA did not connect either description to a specific, present failure in E.R.’s ability to function independently apart from driving.

[25] Moreover, there was evidence of grandiose thinking, but even accepting Dr. Knight's testimony about those claims in full, it goes only to the content of E.R.’s beliefs. Nothing in the record connects these beliefs, however exaggerated, to a functional breakdown in E.R.’s ability to manage his own affairs. As to finances, Dr. Knight testified that E.R. had “consistently given [him] different accounts of his finances” and he doubted E.R.’s ability to manage his income. Id. at 17. But inconsistent disclosures to a treating physician are not the same as an inability to manage one's money, and the VA offered no evidence—such as evidence of unpaid bills or reckless dissipation of assets—that E.R.’s finances had in fact gone unmanaged. At the hearing, Dr. Knight agreed that E.R. was eating well and at a normal weight. Moreover, he could point to nothing beyond food in E.R.’s beard and a misbuttoned shirt to support a claim of inconsistent hygiene.

[26] E.R. testified that he did not disagree with his diagnosis and that he had his own psychiatrist, who supported alternatives to medication. His history of medication non-compliance is, like his current refusal to medicate, evidence of a treatment choice, and the VA presented no evidence connecting either to a present inability to function independently. Moreover, the 2023 commitment reflects a past finding of grave disability but says nothing, standing alone, about whether E.R.’s bipolar disorder left him in danger and unable to function independently three years later. And although the trial court found that a temporary commitment was warranted in part due to E.R.’s 2020 stay at the Logansport State Hospital, the record does not support treating that stay as evidence of grave disability. E.R. volunteered information about those events and testified without contradiction that his 2020 stay arose from a competency evaluation conducted in an unrelated criminal matter. The VA offered nothing to connect that stay to E.R.’s current functioning six years later in July 2026.

[27] Dr. Knight's remaining concerns rested on what manic episodes do to patients as a class rather than on what this episode had done to E.R. He testified that “[c]ontinued manic episodes have demonstrated that there is a lifetime risk of increased suicidality up to 15 times that of the general population,” and that “individuals in acute manic states have significantly more interactions with law enforcement, with activities that could lead to self-harm to themselves or others.” Id. at 18. He described the reasoning of people in manic episodes in the same register—their limited ability “to focus and engage meaningfully with others” and their difficulty “maintaining appropriate relationships and boundaries.” Id. The VA elicited no testimony that E.R. had harmed himself or expressed suicidal ideation, and although the record describes an encounter between E.R. and VA officers, and a disagreement at a gas station, the VA did not tie these events to an inability on E.R.’s part to manage his own affairs.

[28] The collective grounds the trial court listed—denial of illness, refusal to medicate, grandiosity, lack of sleep, a history of medication noncompliance, the 2020 Logansport Hospital stay, the 2023 commitment, and the collision with the VA wall—do not supply, separately or together, evidence that, even when credited in full and viewed in the light most favorable to the trial court's finding, establishes what the statute requires: that the symptoms of mental illness result in E.R. being unable to function independently. For these reasons, we conclude that E.R. established prima facie error in the finding that he was gravely disabled. We, therefore, reverse the temporary commitment order.

[29] Reversed.

FOOTNOTES

1.   The order cites Indiana Code sections defining mental illness and grave disability that, effective July 1, 2026, were repealed and recodified without changing the two bases for grave disability at issue in this case. We refer to the recodified sections. Moreover, although E.R. requests that we remand for correction of the citations, we need not do so because we are reversing on the sufficiency of the evidence. Likewise, we need not address his other arguments, which include a challenge to the use of evidence of his prior commitment.

Foley, Judge.

Brown, J., and Weissmann, J., concur.