COA: Moot involuntary commitment order was appropriate

A woman who was permitted to challenge her involuntary commitment order by the Indiana Supreme Court did not sway the Court of Appeals of Indiana on remand from its original decision after it concluded again that her temporary commitment was appropriate.

After her mental health began to significantly decline, E.F. was taken to the St. Vincent Stress Center during a manic episode. She had been exhibiting increasingly erratic behavior and had previously stopped treating her diabetes, bipolar disorder and other medical conditions for several days.

St. Vincent applied for emergency detention of E.F., and the Marion Superior Court entered an involuntary temporary commitment order after finding her gravely disabled and unable to take care of herself or control her diabetes, which caused further medical issues. E.F.’s family also expressed concerns about not feeling equipped to “keep her safe.”

E.F. appealed, but her commitment order expired while the appeal was pending. As a result, the Court of Appeals dismissed the appeal, pointing to the Indiana Supreme Court’s decision in T.W. v. St. Vincent Hospital and Healthcare Center, Inc., 121 N.E.3d 1039 (Ind. 2019), reh’g denied.

T.W. held that “temporary commitment appeals should be, as a rule, dismissed as moot, though in rare circumstances a question of great public importance may justify not dismissing the otherwise moot appeal.”

On transfer, a split Indiana Supreme Court remanded for the lower appellate court to consider any arguments the parties may have about mootness and the public-interest exception, finding that E.F. should have the opportunity to make those arguments at the COA. The justices advised in that per curiam opinion that “T.W. does not signal that appellate courts should rarely address the merits of appeals for expired temporary commitment orders.”

On remand, and albeit finding that the issues E.F. raised involve questions of great public interest, the Court of Appeals ultimately reaffirmed its original decision in In the Matter of the Civil Commitment of E.F. v. St. Vincent Hospital and Health Care Center, Inc. d/b/a St. Vincent Stress Center, 21A-MH-1332.

At the outset, the COA declined to accept E.F.’s request that it find “temporary commitments are never moot” because the appellate court can grant effective relief.

“In E.F. II, our Supreme Court held that the public interest exception ‘should be applied on a case-by-case basis[,]’ and that, while appellate courts ‘may’ issue an opinion in a moot temporary commitment appeal, we are not required to do so in ‘every’ case,” Senior Judge Edward Najam wrote. “In light of our Supreme Court’s decision in E.F. II., we review E.F.’s claims on the merits.”

Turning to the merits, the appellate court ruled that St. Vincent was not required to prove that E.F. was afforded an opportunity to agree to voluntary treatment. Instead, all the hospital was required to prove by clear and convincing evidence was that E.F. was mentally ill and either dangerous or gravely disabled, and that detention or commitment of E.F. was appropriate.

The court also disagreed with E.F.’s assertion that St. Vincent failed to show her involuntary commitment was appropriate and while a “less restrictive means of treatment” was not. It cited a psychiatrist’s opinion that E.F. was gravely disabled, even after being prescribed medication for her mania and bipolar disorder.

The COA concluded that the evidence clearly and convincingly “demonstrates that E.F. is in danger of coming to harm because she suffers from a substantial impairment of her judgment, reasoning, and behavior.”

“We conclude that this appeal is not moot, and we hold that St. Vincent presented sufficient evidence to support the trial court’s order of temporary involuntary commitment,” Najam wrote. “The court’s involuntary commitment order represents a conclusion that a reasonable person could have drawn. The judgment of the court is affirmed.”