Officials at Designated Hospital That Refused to Admit Emergency Detainee Can Be Held in Contempt, but Permitted to Refuse Admission If Hospital Lacks Adequate Space or Staff

Article excerpt

In a case characterized as exemplifying "a national trend," the Indiana Court of Appeals held that a trial court has the authority to determine that hospital officials violated the law when they refused to admit a man deemed mentally ill and dangerous and judicially committed for a seventy-two-hour emergency detention. However, the appellate court vacated a contempt order and ordered a rehearing because the trial judge failed to give hospital officials an opportunity to explain their decision to deny admission.

In Indiana, designated community mental health centers (CMHCs) contract with the state to provide services within exclusive geographic territories to individuals with mental health needs and to provide a continuum of care. Each CMHC "is obligated to provide accessible services for all individuals, within the limits of its capacity, in its exclusive geographic primary service area."

In this case, a trial judge sought to use Indiana's emergency detention statutes to obtain mental health care for an individual who had come before the court on a criminal charge and who was well known because he had been previously arrested several times. When two physicians at a CMHC hospital declined to accept the individual after the trial court approved the emergency detention, the individual was taken to another hospital where he remained strapped to a bed. In response, the trial court ordered a "show cause" hearing.

At the hearing, a sheriff testified that physicians at the CMHC hospital indicated the hospital had bed space available. The judge complained the hospital had refused for three days to accept the individual even though it was the "catch basin" for this community and as a result the individual was placed in another hospital unprepared to handle such individuals with the county paying for this stay. The judge also noted that physicians at the hospital indicated they absolutely refused to admit anyone after seven o'clock and this was the third time this year this had happened.

As a result, the trial court ordered two hospital officers present at the hearing jailed for twenty-four hours, ordered the hospital to reimburse the county for the individual's medical expenses and the cost of posting police officers at the hospital where the individual was currently placed, and ordered the hospital to immediately find an appropriate placement for the individual. Later that day, the individual was admitted to the CMHC hospital pursuant to a new emergency detention order. The CMHC hospital appealed the court's contempt order.

The appellate court acknowledged that the problem the trial court identified is significant and that trial judges, whose responsibilities include protecting public safety and supporting humane conditions in local jails, are frustrated by the lack of immediate, acute mental health treatment for incarcerated individuals. The court noted that in many communities, jails and prisons have become the largest providers of mental health services. …