IN THE COURT OF APPEALS OF IOWA
No. 15-0501
Filed August 19, 2015
IN THE MATTER OF J.G.,
Alleged to be Seriously Mentally Impaired,
J.G.,
Respondent-Appellant.
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Appeal from the Iowa District Court for Johnson County, Douglas S.
Russell, Judge.
J.G. appeals from a district court order requiring hospitalization due to his
serious mental impairment. AFFIRMED.
Kristin L. Denniger, Cedar Rapids, for appellant.
Thomas J. Miller, Attorney General, Gretchen Witte Kraemer, Assistant
Attorney General, Janet M. Lyness, County Attorney, and Elizabeth Dupuitch,
Assistant County Attorney, for appellee State.
Considered by Doyle, P.J., and Mullins and Bower, JJ.
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DOYLE, P.J.
J.G. appeals the district court’s order finding him to be seriously mentally
impaired and requiring his hospitalization. We affirm.
I. Background Facts and Proceedings
J.G. is currently serving a four-year sentence for assault and domestic
abuse assault. He is scheduled to be discharged sometime in August 2015. In
May 2014, J.G. assaulted a peer while at the Mt. Pleasant Correctional Facility.
Several months later, in July, J.G. lunged at staff and made threats to assault
them while at the Clarinda Correctional Facility. In October, while at the Clarinda
facility, J.G. destroyed items in his cell by smearing feces and urine on them,
threatened to assault staff, and tied a bag around his head. In November, J.G.
again destroyed items in his cell, tore up his mattress, played with feces, and
plugged the toilet. He was emergently treated at least three times in October and
November with medications due to extreme agitation and disruption.
On November 20, 2014, J.G. was transferred to the Iowa Medical and
Classification Center (IMCC) in Coralville. An application for order of involuntary
hospitalization was filed and on December 16, 2014, a judicial hospitalization
referee entered an order pursuant to Iowa Code section 229.13 (2013) finding
J.G. to be seriously mentally impaired and ordering him to be placed for a
complete psychiatric evaluation and appropriate treatment at the Mental Health
Institute (MHI) in Independence. The order further provided that J.G.’s “actual
transfer of placement to MHI Independence is subject to the term of [his] present
incarceration, if applicable, and a safety and security assessment by MHI staff.”
J.G. remained incarcerated at IMCC in Coralville.
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J.G. appealed the referee’s order to the district court. A hearing was held
on March 9, 2015. Dr. Keller, a doctor at IMCC, and J.G. testified at the hearing.
The district court entered its ruling the same day concluding:
The State of Iowa has established by clear and convincing
evidence that [J.G.] is seriously mentally impaired as defined by
[Iowa Code] section 229.1(17). The Court further concludes by
clear and convincing evidence that [J.G.] lacks insight into his
illness and lacks sufficient judgment to make responsible decisions
with respect to his medical treatment, particularly the requirement
of medication when not under commitment and would be at risk to
himself and others if not under civil commitment for appropriate
psychiatric monitoring and treatment. The Court concludes that the
commitment should remain in place, that the current alternative
placement at IMCC is appropriate, and that if [J.G.] takes the
prescribed medication as directed, the commitment will be serving
its purpose.
The court denied and dismissed J.G.’s appeal. J.G. now appeals.
II. Standard of Review
We review sufficiency of the evidence challenges in involuntary
commitment appeals for errors at law. See In re B.B., 826 N.W.2d 425, 428
(Iowa 2013). The district court’s findings of fact are binding on us if supported by
substantial evidence. See In re J.P., 574 N.W.2d 340, 342 (Iowa 1998).
“Evidence is substantial if a reasonable trier of fact could conclude the findings
were established by clear and convincing evidence.” Id. Clear and convincing
evidence “means that there must be no serious or substantial doubt about the
correctness of a particular conclusion drawn from the evidence.” See B.B., 826
N.W.2d at 428.
III. Serious Mental Impairment
J.G. contends the State failed to prove by clear and convincing evidence
that he is seriously mentally impaired. Iowa Code section 229.1(17) provides
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that a person is “seriously mentally impaired” where the person is mentally ill
and, “because of that illness lacks sufficient judgment to make responsible
decisions with respect to the person’s hospitalization or treatment,” and is likely,
if allowed to remain at liberty, to inflict physical injury on himself or others or to
inflict emotional injury on the designated class of persons. See also B.B., 826
N.W.2d at 432. “Likely” is construed to mean “probable or reasonably to be
expected.” In re Oseing, 296 N.W.2d 797, 801 (Iowa 1980). “[T]he
endangerment element requires a predictive judgment, based on prior
manifestations but nevertheless ultimately grounded on future rather than past
danger.” In re Mohr, 383 N.W.2d 539, 542 (Iowa 1986) (internal quotation marks
omitted). The danger the person poses to himself or others must be evidenced
by a “recent overt act, attempt or threat.” Id. (internal quotation marks omitted).
“In the context of civil commitment . . . an ‘overt act’ connotes past aggressive
behavior or threats by the respondent manifesting the probable commission of a
dangerous act upon himself or others that is likely to result in physical injury.” In
re Foster, 426 N.W.2d 374, 378 (Iowa 1988). Overt acts include behavior such
as threats to kill. See id. at 379.
Dr. Keller, board certified in adult psychiatry, testified J.G.’s “diagnosis
currently has been Schizoaffective Disorder, Bipolar type,” which is considered a
mental illness under DSM-V. The doctor’s March 4, 2015 report, considered by
the court, states the same diagnosis. The report also indicates that in the
doctor’s judgment, J.G. is mentally ill. At the hearing, the doctor opined J.G. was
seriously mentally impaired. We find this evidence sufficient to establish J.G. is
mentally ill.
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At the hearing, Dr. Keller also opined J.G.’s “judgment is so impaired and
so incapacitated that he’s not able to choose the proper course of treatment for
himself,” and that J.G. was not capable of realizing and making rational decisions
with respect for his need for treatment. The doctor explained:
[J.G.] initially was compliant with medications on the basis of
this order; otherwise, he had been taking medications that he
believed would be helpful but weren’t effective and they were, as he
had told me, the easiest to get off in the community when he left.
I have been able to at least start these medications that have
partially treated him, but he continues to have delusional thoughts
about his past, his military history, various other aspects including
his family life.
He remains disorganized in giving me his history. I still have
limited history from him, and I do believe that even with his last visit
he has ideas that he’s receiving different medications than what’s
been prescribed despite all the orders remaining the same.
I did note for him that we did have a change in one of the
generic medications which was the Depakote. We went from a
gray tablet to a white tablet, but he believes the other medications
have changed and have been changing.
So I believe that he has managed to maintain some
improvement in our structured care in the mental health unit, but I
believe he remains at the disorganized high risk of stopping his
medications.
The doctor also testified he believed commitment was necessary in order
to enable J.G. to continue his medication. The doctor’s March 4 report also
states J.G. is not capable of making responsible decisions with respect to his
treatment. We find this evidence sufficient to establish J.G. lacks sufficient
judgment to make responsible decisions with respect to his treatment.
Dr. Keller’s March 4 report indicates, in the doctor’s judgment, that J.G. is
likely to injure himself or others. The report explains:
He had a history when not on meds of assaulting peers and
assaulting staff. In October [2014] he tied a bag around his head,
and in early November [2014] he tore up things in his cell and
smeared feces. This combined with his history of agitation when off
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medication is very disruptive to the unit. When not on consistent
medications or ineffective medication, he had been agitated and
made numerous verbal threats to staff besides the above noted
disruptions and fights.
The report also indicates that in the doctor’s judgment, J.G. is likely to inflict
severe emotional injury on those unable to avoid contact with him, explaining that
if J.G. “is not on medications, he can become very activated and not rest at night
keeping peers up making noises and being loud, yelling at unseen stimuli, etc.”
At the hearing, the doctor also opined J.G. would be a danger to himself if left
untreated. In particular, it was the doctor’s opinion that if left untreated, J.G. was
likely to inflict serious emotional injury on those who are unable to avoid contact.
He explained, “[J.G.] has displayed in the past very disruptive actions on the
units he’s been on. Currently, again, there have been some complaints; but he
has been more redirectable since on treatment. But without treatment, I do
believe that he will decompensate.”
J.G. argues the “endangerment element” was not proven by clear and
convincing evidence because there were no recent overt acts, attempts, or
threats. To support this contention, J.G. claims there were no incidents beyond
May of 2014—approximately ten months prior to the hearing on the appeal from
the hospital referee’s decision. We disagree. The record shows multiple threats
to harm peers and staff, assault on staff, and self-harm, including: May 2014,
J.G. assaulted a peer; July 2014, J.G. attempted to assault a correctional officer
and continually made threats to staff; October 2014, J.G. destroyed his cell,
threatened to assault staff, and tied a bag around his head; and November 2014,
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J.G. again destroyed his cell and was extremely agitated and disruptive, at which
time he was moved to the IMCC and adjudged “seriously mentally impaired.”
The hospitalization hearing was held on December 16, 2014. There can
be no genuine dispute—and J.G. did not claim otherwise at the hearing—that the
incidents in 2014 (particularly the October and November incidents) were “recent
overt acts.” The appeal hearing was held on March 9, 2015, almost three
months after the hospitalization hearing. The nature of the hearing was a trial de
novo. See Iowa Code § 229.21(3)(c). Since the time of the hospitalization
hearing, J.G. has been under court-ordered treatment and on consistent
medications; as a result, and as hoped, his condition has improved, and he has
ceased the threats to staff. We agree with the State that although a recent overt
act is required to prove the dangerousness element, the focus is not solely on the
temporality of the act, particularly under the circumstances presented here.
The endangerment element “requires a predictive judgment, ‘based on
prior manifestations but nevertheless ultimately grounded on future rather than
past danger.’” Mohr, 383 N.W.2d at 542. Dr. Keller testified J.G. was so
seriously mentally impaired that J.G. was not able to choose the proper course of
treatment for himself. Although J.G. managed to maintain some improvement in
the structured care of the mental health unit, Dr. Keller believed J.G. remained
“at the disorganized high risk of stopping the medications.” The doctor believed
J.G. would be a danger to himself if left untreated. The doctor opined J.G. is
likely to inflict serious emotional injury on those who are unable to avoid contact
with him if J.G. is left untreated. Finally, the doctor felt commitment was
necessary in order to enable J.G. to continue his medications. Taking all of the
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above into consideration, we find the evidence sufficient to support the trial
court’s finding that J.G. is likely to injure himself or others if released without
treatment.
IV. Continuance
J.G. argues the district court abused its discretion in denying his request
for a continuance. Denial of a motion to continue is reviewed for an abuse of
discretion. See In re C.W., 554 N.W.2d 279, 281 (Iowa Ct. App. 1996).
Before cross-examining Dr. Keller, J.G. moved to continue the
proceedings “until he can get some further information and documents for his
own benefit.” The court denied the motion and the hearing proceeded. He did
not reveal what “further information and documents” he sought at the hearing and
he does not do so on appeal. Under the circumstances, the district court did not
abuse its discretion in denying the motion to continue.
V. Conclusion
Because there is sufficient evidence to conclude J.G. is mentally ill, lacks
sufficient judgment to make reasonable decisions as to his treatment, and that
without continued involuntary commitment and medical treatment he is likely to
injure himself or others, we agree with the district court that J.G. is “seriously
mentally impaired as defined by section 229.1(17).” Consequently, we affirm the
district court’s ruling on appeal.
AFFIRMED.