MEMORANDUM DECISION
Pursuant to Ind. Appellate Rule 65(D),
this Memorandum Decision shall not be FILED
regarded as precedent or cited before any Dec 18 2018, 9:24 am
court except for the purpose of establishing CLERK
the defense of res judicata, collateral Indiana Supreme Court
Court of Appeals
estoppel, or the law of the case. and Tax Court
ATTORNEY FOR APPELLANT
Danielle L. Flora
Fort Wayne, Indiana
IN THE
COURT OF APPEALS OF INDIANA
In the Matter of the Civil December 18, 2018
Commitment of: Court of Appeals Case No.
18A-MH-1580
M.H.,
Appeal from the Allen Superior
Appellant, Court
v. The Honorable David J. Avery,
Judge
Kristen Ludwig and State of Trial Court Cause No.
Indiana, 02D09-1805-MH-537
Appellees.
Brown, Judge.
Court of Appeals of Indiana | Memorandum Decision 18A-MH-1580 | December 18, 2018 Page 1 of 11
[1] M.H. appeals the trial court’s June 6, 2018 Order of Temporary Commitment
of M.H. We affirm.
Facts and Procedural History
[2] On May 30, 2018, Kristen Ludwig, a therapist at St. Joseph Hospital in Fort
Wayne, Indiana, filed a petition for involuntary commitment related to M.H.
On June 6, 2018, the trial court held a hearing at which it heard testimony from
Dr. Smitha Patibandla, M.H., M.H.’s father, and Ludwig. Dr. Patibandla
testified that she accepted M.H. for an inpatient stay on May 24, 2018, and that
M.H. had been brought to the emergency room by her mother and had physical
complaints. Dr. Patibandla testified the emergency room doctors did not find
anything physically wrong with her but were concerned because M.H. was
“talking about having a microchip inside of her neck,” they asked for a
psychiatric consultation, and M.H. was admitted because Dr. Patibandla
thought she was paranoid and having delusions. Transcript Volume II at 3.
Dr. Patibandla testified that Adderall pills were found on M.H., M.H. indicated
she had an old prescription, and “[s]o, we gave [M.H.] a diagnosis of
unspecified psychosis and a substance induced (inaudible) at that time.” Id. at
4.
[3] When asked to provide specific facts upon which she based her observation that
M.H. was paranoid, Dr. Patibandla testified:
She was talking about this microchip in her neck and I think she
was discussing this with family members and she was asking her
sister to check and see if in fact she did have a microchip in her
Court of Appeals of Indiana | Memorandum Decision 18A-MH-1580 | December 18, 2018 Page 2 of 11
neck. So, I talked with her and said how is it possible that she
could have a microchip in her neck and why would somebody do
that to her? Um, she was trying under a strong belief that there
was a microchip in her neck and she was stating that this was
likely to related to um, a treatment for her depression and anxiety
problems. I even asked her, who would put a chip in your neck
and why would they do it? So, she said it could be a doctor and
she doesn’t know who put it. I even asked her; do you think it’s
possible that somebody could put a chip in your neck without
your consent or without your knowledge? And, she thinks yes it
is possible. So, these are some of the things that I was really
concerned about.
Id. at 4-5. Dr. Patibandla further testified that M.H. “has been making
extensive notes, she has been writing down things, and she has made several
attempts to elope from the unit both on Sunday and Monday” and that a drug
screen was eventually performed which was positive for amphetamine. Id. at 5.
She testified that M.H. had been previously diagnosed with depression, anxiety,
post-traumatic stress disorder, and ADHD and had been seeing a psychiatrist.
She testified “[w]e gave her a diagnosis of unspecified psychosis. Um,
substance abuse psychosis and amphetamine induced.” Id. at 7. When asked if
M.H. was at substantial risk that she will harm herself or others, Dr. Patibandla
testified “she will likely come to harm because of her symptoms. I would not
say directly through herself or others but she is also responsible for three young
children. I don’t think she is at risk of directly killing herself or killing others at
this time.” Id. at 8. When asked if M.H. was in danger of coming to harm
because of an inability to provide for her food, clothing, shelter, or other
essential human needs, Dr. Patibandla testified: “I will say yes. If she refuses
Court of Appeals of Indiana | Memorandum Decision 18A-MH-1580 | December 18, 2018 Page 3 of 11
medications and if she continues to abuse drugs.” Id. at 9. When asked
whether M.H. had a substantial impairment or obvious deterioration of her
judgment, reasoning, or behavior that affected her ability to function
independently, Dr. Patibandla testified: “It would significantly affect her
reasoning and judgment.” Id. She indicated that M.H. was dressed
appropriately, eating, and functioning fine but that she was concerned for the
three children as M.H. had a full-time job and stated she was using Adderall
because it gave her more energy. When asked what essential need M.H. would
not be able to provide for herself, Dr. Patibandla testified “I would say safety of
herself and her kids.” Id. at 10.
[4] M.H. testified that she was employed and attended evening courses. She
indicated that she did not believe she had a microchip in her neck. When asked
“where that is coming from,” M.H. testified “[m]y sister told my mother and
my mother told the doctors in the E.R. that she was worried that I would cut
myself because of that statement.” Id. at 13. She indicated she had never said
she had a microchip in her neck, and that she was diagnosed with PTSD by a
counselor in 2009 or 2010 and with ADHD in February 2017. She stated she
saw a therapist once a week since December 2017, was taking the medication
she was given, and would continue to do so if released. She indicated she tested
positive for amphetamines which was from the Adderall and did not have a
current prescription for Adderall. When asked if it was accurate that she took
Adderall because she was stressed, M.H. replied: “It is not completely accurate
but not completely wrong. [M]y children’s grandmother puts a lot of pressure
Court of Appeals of Indiana | Memorandum Decision 18A-MH-1580 | December 18, 2018 Page 4 of 11
on me and I do feel that I have to be super mom from time to time when she is
putting that pressure on me. And, since this hospital stay in two weeks, she has
put in an order to get temporary custody of my children.” Id. at 14-15. She
indicated she was attending AA meetings twice a week, she provides food,
clothing, and shelter for herself, and there is no area in which she is unable to
function on her own. M.H. testified: “I have been doing everything in my
power to get better. This feels more like a step back than helping.” Id. at 16.
She indicated she has never attempted to injure herself, and when asked if she
knew why her sister concluded that she may try to cut out a microchip, M.H.
answered: “Yes, I think I know why. I was having a hypothetical conversation
with her just about many things and I can’t have those conversations with my
sister or my mother. They take it very literal and it’s not meant to be taken
literally.” Id. at 19. M.H. indicated the Adderall was something she obtained
outside of a doctor’s office. When asked if she felt the Adderall helped her in
keeping things together, M.H. answered: “More than keeping things together,
but going above and beyond. I can keep things together on my own, it’s the
going above and beyond and being super mom; that’s what I was struggling
with, the pressures from the grandmother.” Id. at 20.
[5] M.H.’s father testified that he saw her at least twice a week and spoke with her
almost daily, he had never heard M.H. talk about microchips in her neck or
voice any other concerns like delusional thoughts, she provided food, clothing,
and shelter for herself and her children, the children are very well-behaved and
taken care of, and he had no concerns about M.H.’s ability to care for herself or
Court of Appeals of Indiana | Memorandum Decision 18A-MH-1580 | December 18, 2018 Page 5 of 11
her children. He testified that M.H.’s home was clean, there was food, and he
had no concerns about the children remaining there.
[6] Dr. Patibandla testified again and indicated that she discussed the microchip
with M.H. and testified: “I said who would put it? She said a doctor would put
it. And why would a doctor put it? Because sometimes doctors do that to treat
depression and anxiety symptoms. I said I have been a psychiatrist for such a
long time and I have never done or seen anything like that. So, I have
challenged her delusions and she continued to make those statements.” Id. at
27-28. She also testified that M.H. “has talked to multiple staff on the unit,
telling them about a microchip and she seems to kind of believe in that delusion
very much.” Id. at 28. When asked how long she anticipated that M.H. would
remain in inpatient care, Dr. Patibandla stated “[s]he has a distress plan . . . so I
could discharge her as early as within the next twenty-four hours” and “I just
need to make sure that she has appointments and just need to confirm that she
can follow-up on an outpatient basis and then I can discharge her within the
next twenty-four hours.” Id. at 29. Dr. Patibandla indicated she had seen
improvement over the prior several days and attributed the improvement to
clearing up the substance abuse psychosis, the structured environment and lack
of stress, and the antipsychotic medication. She also testified that she had seen
quite a few patients experience significant psychotic symptoms with Adderall
use. Ludwig testified that she was the lead therapist on the adult unit at St.
Joseph Hospital and that M.H. had stated to her and a nurse manager that she
had a microchip in her neck.
Court of Appeals of Indiana | Memorandum Decision 18A-MH-1580 | December 18, 2018 Page 6 of 11
[7] M.H. testified again and, when asked “[y]ou say you have a microchip in your
neck or a hypothetical conversation, I don’t understand. Can you explain that
for us,” answered: “Yes, I constantly have hypothetical conversations. So, I
was bringing that to their attention and I had said the word hypothetical at least
twenty times each time I sat in that chair and there are video tapes, so I would
say let’s bring the evidence.” Id. at 34.
[8] The trial court stated:
Alright. [M.H.], out of an abundance of caution, I am going to
go ahead and grant the temporary commitment with the
understanding of what I am hearing that uh, you will be
transitioned to an outpatient setting here very shortly. I think the
evidence that the fact that you came in and I am glad you came
in voluntarily with your mother and as I understand that your
testimony was that for whatever reason what was going on in
your life at that point that you were having some concerns and
obviously were taking some medications to help deal with that
situation, I just want to make sure that as you make that
transition out of the hospital setting um, and now that you have
the Adderall out of your system and I believe from the testimony
that you are thinking more clearly that I just want to make sure
that that transition goes well for you.
Id. at 35-36. M.H. asked when she would be going home for her children, and
the court replied “I believe Dr. Patibandla felt that within twenty-four hours
you would head home” and “I want to make sure that transition goes well and
that as you make that transition if you feel you still need help that there is help
readily available for you.” Id. at 36.
Court of Appeals of Indiana | Memorandum Decision 18A-MH-1580 | December 18, 2018 Page 7 of 11
[9] The court issued an Order of Temporary Commitment dated June 6, 2018. The
court’s order found that M.H. is suffering from mental illness and that she is
gravely disabled.1 The court found she was in need of commitment for a
temporary period not to exceed ninety days, found Park Center was an
appropriate facility, and ordered the facility or attending physician to submit a
treatment plan within fifteen days of M.H.’s admission.2
Discussion
[10] M.H. requests this Court to reverse her involuntary commitment and argues the
trial court’s decision is not supported by sufficient clear and convincing
evidence of grave disability. 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 §§ 12-26-6.3 Ind. Code §
12-26-6-1. The petitioner is required to prove by clear and convincing evidence
1
The pre-printed sentence in the order that the respondent is dangerous to self or others is crossed out.
2
Entries in the chronological case summary (“CCS”) indicate that the court scheduled and then cancelled a
status hearing for June 13, 2018. One of the entries indicating the hearing was cancelled states: “Reason:
Other.” Appellant’s Appendix Volume 2 at 3.
3
The Indiana Supreme Court has stated:
In Indiana, an adult person may be civilly committed either voluntarily or involuntarily.
Involuntary civil commitment may occur under four circumstances if certain statutorily
regulated conditions are satisfied: (1) “Immediate Detention” by law enforcement for up
to 24 hours, see Ind. Code § 12-26-4 et seq.; (2) “Emergency Detention” for up to 72
hours, see Ind. Code § 12-26-5 et seq.; (3) “Temporary Commitment” for up to 90 days,
see Ind. Code § 12-26-6 et seq.; and (4) “Regular Commitment” for an indefinite period of
time that may exceed 90 days, see Ind. Code § 12-26-7 et seq.
Civil Commitment of T.K. v. Dep’t of Veterans Affairs, 27 N.E.3d 271, 273 n.1 (Ind. 2015). Here, the court
entered an order of temporary commitment.
Court of Appeals of Indiana | Memorandum Decision 18A-MH-1580 | December 18, 2018 Page 8 of 11
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)4; Civil Commitment of T.K., 27 N.E.3d at 273-276. 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.
See T.D. v. Eskenazi Health Midtown Cmty. Mental Health Ctr., 40 N.E.3d 507, 510
(Ind. Ct. App. 2015). In order to be clear and convincing, the existence of a fact
must be highly probable. Id. In reviewing the sufficiency of the evidence
supporting a determination requiring clear and convincing evidence, we will
consider only the evidence favorable to the judgment and all reasonable
inferences drawn therefrom, and we will not reweigh the evidence or judge the
credibility of witnesses. Id.
[11] M.H. maintains that the evidence does not support the court’s determination
that she is “gravely disabled.” Ind. Code § 12-7-2-96 provides:
“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; or
(2) has a substantial impairment or an obvious
deterioration of that individual’s judgment, reasoning, or
4
Ind. Code § 12-26-2-5 expressly provides that it applies under Ind. Code §§ 12-26-6.
Court of Appeals of Indiana | Memorandum Decision 18A-MH-1580 | December 18, 2018 Page 9 of 11
behavior that results in the individual’s inability to
function independently.
[12] M.H. argues that no evidence was presented that she was unable to provide for
her food, clothing, shelter, or other essential human needs or that she had a
substantial impairment or deterioration of judgment that resulted in her
inability to function independently. She argues she was employed and enrolled
in college, her home was clean and there was food in the home, she was taking
medications as prescribed and would do so after her release, she had weekly
appointments with a therapist and attended Alcoholic Anonymous meetings
twice per week, she dressed appropriately, and her children were well-cared for.
M.H. further argues that, although Dr. Patibandla testified that she was in
danger of coming to harm if she refused medications and continued to abuse
drugs, Dr. Patibandla also testified that M.H. was taking her medications and
asserts no evidence was presented that she would continue to abuse drugs. She
also argues that, while Dr. Patibandla indicated that the essential need that she
was not providing was the safety of herself and her children, there was no
evidence presented that her or her children’s safety was ever in jeopardy and the
trial court did not find that she was dangerous. She also argues that nothing in
the record indicates that she was unable to function independently.
[13] The record reveals that M.H. tested positive for amphetamines which was from
the Adderall she had been using and that she did not have a current prescription
for Adderall. M.H. presented to the hospital staff stating there was a microchip
in her neck. Dr. Patibandla indicated that M.H. suffered from a substance
Court of Appeals of Indiana | Memorandum Decision 18A-MH-1580 | December 18, 2018 Page 10 of 11
abuse psychosis that was amphetamine induced, that she would likely come to
harm because of her symptoms, that she was in danger of coming to harm
because of an inability to provide for her food, clothing, shelter, or other needs
if she refuses medications and continues to abuse drugs, and as a result of her
mental illness M.H. had a substantial impairment or obvious deterioration of
her judgment and reasoning. The court heard the testimony of Dr. Patibandla
and Ludwig regarding M.H.’s statements and behavior at the hospital, her
diagnoses, and her use of Adderall. The court was able to observe M.H. and
the witnesses and assess their demeanors and testimony.
[14] Based upon the record, we conclude that clear and convincing evidence
supported the trial court’s finding that M.H. was gravely disabled for purposes
of her involuntary commitment.
Conclusion
[15] For the foregoing reasons, we affirm the trial court’s June 6, 2018 order.
[16] Affirmed.
Bailey, J., and Bradford, J., concur.
Court of Appeals of Indiana | Memorandum Decision 18A-MH-1580 | December 18, 2018 Page 11 of 11