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Agreeing to consider a mental health commitment case despite the patient’s prior release, a split Court of Appeals of Indiana has reversed the imposition of a special condition prohibiting the patient from consuming alcohol or drugs during his outpatient treatment.
The case began in February, when Dr. Hugo Espinsoa applied for emergency detention of 62-year-old Air Force veteran G.H. In the application, Espinosa stated that G.H. has not been taking his psychotropic medications, and that G.H. had reported suicidal and homicidal ideation.
G.H. was admitted to the Veterans Affairs hospital in Indianapolis later that same day. Two days later, the hospital requested a temporary involuntary commitment of G.H.
A statement from Dr. Andrew Filipowicz identified G.H.’s mental health diagnosis as schizoaffective. Filipowicz also noted that G.H. was refusing insulin, antipsychotic medications and housing, and was not eating, which was resulting in weight loss.
At an evidentiary hearing in Marion Superior Court, Filipowicz said G.H. sometimes acknowledged a history of mental health diagnoses, including a history of visual and auditory hallucinations. G.H. had taken antipsychotic medications in the past but stopped taking the medication in 2018.
Filipowicz diagnosed G.H. with schizoaffective disorder, bipolar type. G.H. exhibited symptoms including delusional beliefs that residents were entering his room at night along with impulsivity and irritability. On one occasion, a “code orange” was called to summon a disruptive behavior team when G.H. became upset and began slamming things down.
G.H. was prescribed a twice daily dose of Risperidone, which he initially refused but then began to take voluntarily. G.H. was showing improvement on the medication, and while he was taking the medication on his own, he was still inpatient.
Filipowicz testified that he believed G.H. had only limited insight into his mental illness.
For his part, G.H. testified that he didn’t have schizoaffective disorder, but only symptoms he characterized as “depression.” He also testified that he didn’t want to take Invega Sustenna, the drug he had stopped in 2018, but he was willing to continue taking Risperidone.
At the time of the hearing, G.H. was on “escape and assault precautions,” and Filipowicz testified that he was concerned that G.H. was gravely disabled. He noted that if G.H.’s irritable and aggressive behavior were to manifest, he could cause harm to others or himself.
Filipowicz also testified that he was concerned G.H. would not be able to function independently in daily activities such as shopping, preparing food and managing his finances without proper ongoing therapies, and that he believed G.H. was unlikely to continue his psychiatric medication without temporary commitment.
The trial court granted the temporary commitment until May 13, finding G.H. suffered from mental illness and was gravely disabled. In its order, the court also imposed a special condition: If G.H. were discharged to a “wet shelter,” such as his VA apartment, he was not to consume alcohol or drugs except those prescribed.
G.H. appealed, but the hospital argued the appeal was moot because he has already been released.
In agreeing to hear the case, the appellate court said “it presents an opportunity to develop case law on a topic that is relatively undeveloped but likely to recur in this case and others: the proof necessary to impose special conditions upon attaining outpatient status.”
Turning to the merits, the COA first addressed G.H.’s argument that there was insufficient evidence to support the trial court’s finding that he was gravely disable.
The appellate court rejected that argument, pointing to evidence of G.H.’s symptoms, including suicidal and homicidal ideations, among other symptoms.
“That evidence, in addition to the testimony of Dr. Filipowicz that G.H. was gravely disabled — i.e., that his schizoaffective disorder so impaired his ability to function independently and so deteriorated his judgment that he could come to harm without continued treatment in a temporary involuntary commitment — provided ample, clear, and convincing evidence supporting the commitment,” Judge L. Mark Bailey wrote.
But on the second issue — whether there was sufficient evidence to support the special condition — the COA agreed with G.H.
“… (T)he doctor never stated that G.H. should refrain from all alcohol and drug use, such as use of over-the-counter drugs,” Bailey wrote. “Because there was insufficient evidence in the record showing a reasonable relationship between the prohibition on the use of alcohol and drugs and G.H.’s treatment and safety or that of the general public, the special condition should not have been imposed.”
The case was thus remanded to the trial court to strike the special condition prohibiting G.H. from consuming alcohol and drugs during his outpatient treatment.
Judge Elizabeth Tavitas concurred in part and dissented in part with a separate opinion.
Tavitas agreed with the majority that there was sufficient evidence that G.H. was gravely disabled, but disagreed that there was insufficient evidence to support the imposition of the special condition.
“Given the need to avoid non-prescribed drugs and alcohol during treatment with Invega and the implicit reduction in supervision after G.H.’s release from inpatient care, I conclude that the trial court did not abuse its discretion by imposing the special condition of avoiding the consumption of non-prescribed drugs or alcohol,” Tavitas wrote.
Judge Dana Kenworthy concurred in the majority opinion in In the Matter of the Civil Commitment of G.H. v. Richard L. Roudebrush Veterans Affairs Medical Center, 23A-MH-490.
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