IN THE COURT OF APPEALS OF IOWA
No. 15-1621
Filed May 25, 2016
IN THE MATTER OF J.K.,
Appellant,
Alleged to be Seriously Mentally Impaired.
________________________________________________________________
Appeal from the Iowa District Court for Woodbury County, Edward A.
Jacobson, Judge.
A nineteen-year-old woman appeals her civil commitment. REVERSED.
Zachary S. Hindman of Bikakis, Mayne, Arneson, Hindman & Hisey, Sioux
City, for appellant.
Thomas J. Miller, Attorney General, and Gretchen Kraemer, Assistant
Attorney General, for appellee State.
Considered by Tabor, P.J., and Bower and McDonald, JJ.
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TABOR, Presiding Judge.
Nineteen-year-old J.K. appeals from the district court’s order finding she
was seriously mentally impaired. She contests the proof of her mental illness
because she received several different diagnoses and challenges the evidence
she was likely to inflict serious emotional injury on family members if she was not
civilly committed. Because we find the order is not supported by clear and
convincing evidence on the serious-emotional-injury element, we reverse.
I. Facts and Prior Proceedings
Considering information from her physician and family that J.K. was
“becoming increasingly schizophrenic” and “exhibiting bizarre thinking,” on July
21, 2015, a Woodbury county magistrate issued an emergency hospitalization
order under Iowa Code section 229.22 (2015). The magistrate noted J.K. had
“recently driven to Chicago and woke up in a hotel with no memory of having
driven there.”
The next day, J.K.’s mother, T.G.F., filed an application under section
229.6, alleging her nineteen-year-old daughter was suffering from serious mental
impairment. T.G.F. alleged J.K. “has periods of incoherency.” The application
also alleged the teenager was living with “a 38-year-old man who is known for
trafficking” and that she was “doing drugs, drinking, and prostituting.” T.G.F.
asserted her daughter suffered from posttraumatic stress disorder “so her
decision-making skills are not working.” The application also noted instances of
J.K.’s “paranoia.”
The district court appointed Dr. Josette Lindahl to conduct a personal
examination of J.K. to determine if she met the criteria for serious mental
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impairment in section 229.1(14). After an examination of J.K. on July 23, 2015,
Dr. Lindahl reported that J.K. was mentally ill, stating her diagnosis as follows:
“psychosis secondary to the use of synthetic drugs; psychosis nos, cannabis
abuse vs. dependence, patient highly paranoid, suspicious, delusional.” The
doctor opined J.K. exhibited poor judgment and was easily manipulated.
On July 27, 2015, the court issued an order approving J.K.’s request for a
second opinion at a clinic in Rochester, Minnesota, where her mother lived, and
continuing the hospitalization hearing. A periodic report issued in late August
2015 indicated J.K. had failed to obtain the second mental-health opinion and
had returned to Woodbury County. On September 1, 2015, J.K. obtained a
second opinion from John Meyer, a therapist from the Dubuque Mental Health
Center. His diagnosis was “Anxiety Disorder, NOS.” In a letter to the court, he
noted he “would have further sessions to diagnose her more accurately.” J.K.
received a third evaluation on September 10, 2015. Dr. Philip Muller agreed J.K.
was mentally ill, but his diagnosis was antisocial personality disorder. He opined
that because of her mental illness, she lacked sufficient judgment to make
responsible decisions with respect to her hospitalization or treatment. As
supporting facts, he noted “[patient] is involved in risky behavior, adult dancing,
h[istory] of prostitution.”
The district court held a contested commitment hearing on September 14,
2015. The court took judicial notice of the medical reports from Dr. Lindahl and
Dr. Muller, as well as a letter drafted by T.G.F. detailing her concerns that J.K.
was a victim of human trafficking. J.K. and T.G.F. both testified at the hearing.
After reviewing the file, the court decided J.K. was (1) “afflicted with a mental
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illness,” (2) “lacks sufficient judgment to make responsible decisions with respect
to her treatment or hospitalization,” and (3) “is likely, if allowed to remain at liberty
to . . . (b) inflict serious emotional injury on members of her family or others who
lack reasonable opportunity to avoid contact with the respondent.” The court
made a specific finding that it found T.G.F.’s testimony to be credible. The court
decided J.K. was “seriously mentally impaired” and ordered her to be placed at
Associates for Psychiatric Services for further evaluation and outpatient
treatment. The court also ordered J.K. to obtain a substance abuse evaluation.
J.K. appeals from the commitment order.
II. Standard of Review
In appeals from involuntary commitments, we review challenges to the
sufficiency of proof for errors at law. In re B.B., 826 N.W.2d 425, 428 (Iowa
2013). The State must prove the allegations of serious mental impairment by
clear and convincing evidence. Id. Clear and convincing evidence is a less
burdensome standard than proof beyond a reasonable doubt, but more
burdensome than a preponderance of the evidence. Id. Clear and convincing
means we find “no serious or substantial doubt about the correctness of a
particular conclusion drawn from the evidence.” Id.
III. Serious Mental Impairment
J.K. argues the district court erred in finding she suffered from a “serious
mental impairment.” Iowa Code section 229.1(17) defines that phrase:
“[S]erious mental impairment” describes the condition of a
person with mental illness and because of that illness lacks
sufficient judgment to make responsible decisions with respect to
the person’s hospitalization or treatment, and who because of that
illness meets any of the following criteria:
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a. Is likely to physically injure the person’s self or others if
allowed to remain at liberty without treatment.
b. Is likely to inflict serious emotional injury on members of
the person’s family or others who lack reasonable opportunity to
avoid contact with the person with mental illness if the person with
mental illness is allowed to remain at liberty without treatment.
c. Is unable to satisfy the person’s needs for nourishment,
clothing, essential medical care, or shelter so that it is likely that the
person will suffer physical injury, physical debilitation, or death.
The element of dangerousness—that is, the likelihood of a mentally ill
person suffering or inflicting physical or emotional harm—is “constitutionally
necessary” because the commitment statute allows confinement based on
predicted behavior. B.A.A. v. Chief Med. Officer, 421 N.W.2d 118, 124 (Iowa
1988) (explaining dangerousness element creates a legitimate state interest in
commitment). The term “likely” means “probable or reasonably to be expected.”
In re Foster, 426 N.W.2d 374, 378 (Iowa 1988). The likelihood that a mentally ill
person will inflict injury requires proof of a recent overt act, attempt or threat. Id.
In this case, the district court found that because of her mental illness, J.K.
lacked judgmental capacity and met the criteria under only subsection (b),
requiring proof of emotional endangerment. See Iowa Code § 229.1(17)(b).
J.K. challenges that finding on appeal, asserting the record did not contain clear
and convincing evidence that she either (A) had a mental illness or (B) because
of a mental illness was likely to inflict serious emotional injury on members of her
family or others who lacked a reasonable opportunity to avoid her, had she been
allowed to remain at liberty. See id. We will address each challenge in turn.
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A. Mental Illness
J.K. contests the proof of her mental illness because the three mental
health professionals who evaluated her gave three different diagnoses. At the
hearing, she testified:
I’ve got three different opinions from three different people. I
could go to six more people and get six more different opinions. It’s
just a guessing game. It’s unfair for them to be playing the
guessing game. And it’s all based off of false information.
On appeal, her attorney makes the same point:
[T]here is no way that any of the diagnoses amounts to clear
and convincing evidence, because each is undermined by the other
two. Importantly, the district court never made any ruling about the
credibility of any of the three diagnoses. And the record does not
reveal any reason to reject or to accept any one of the diagnoses in
lieu of the other two. In other words, each competing diagnosis
amounts to a serious or substantial doubt about the other two.
The State responds that one diagnosis by a physician is sufficient to
support a finding of mental illness, and none of the mental health providers on
record in this case attest that J.K. is not mentally ill. The State also points out the
evaluations were conducted at different points in time. Notably, Dr. Lindahl
diagnosed J.K. with psychosis not otherwise specified or psychosis secondary to
the use of synthetic drugs in July 2015, when it was reasonable to believe J.K.
was actively using those substances. Whereas, Dr. Muller diagnosed her nearly
two months later, when the drugs may have left her system.
Section 229.1(10) defines “mental illness” as encompassing “every type of
mental disease or mental disorder.”1 J.K. does not provide any authority that a
1
The provision makes an exception for intellectual disabilities, and for insanity,
diminished responsibility, and mental incompetency as those terms are defined in the
criminal code or rules of criminal procedure. See Iowa Code § 229.1(10).
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person is not mentally ill if she receives differing diagnoses of mental diseases or
disorders. We find clear and convincing evidence in the record that J.K. is a
person with a mental illness. See In re B.J.C., No. 13-1916, 2015 WL 5970329,
at *1 (Iowa Ct. App. Oct. 14, 2015) (noting respondent had “many different
diagnoses over a course of time”).
B. Likelihood of Inflicting Serious Emotional Injury
J.K. next argues no evidence in the record supports the district court’s
finding that had she been allowed to remain at liberty, she would likely have
inflicted serious emotional injury on members of her family or others who lacked
a reasonable opportunity to avoid her. See Iowa Code § 229.1(17)(b).
“Serious emotional injury” is defined as:
[A]n injury which does not necessarily exhibit any physical
characteristics, but which can be recognized and diagnosed by a
licensed physician or other mental health professional and which
can be causally connected with the act or omission of a person who
is, or is alleged to be, mentally ill.
Id. § 229.1(16).
As discussed above, the endangerment element requires the court to
make a “predictive judgment, based on prior manifestations.” See In re J.P., 574
N.W.2d 340, 344 (Iowa 1998). But the element is grounded on future, rather
than past, danger of serious emotional injury. See id. One commentator
explained the central purpose of the emotional-injury standard is to “require an
identification of those predictable consequences of mental illness, short of
physical injury to others, but exclusive of injury to property, which justify
rehabilitative state intervention.” Randall Bezanson, Involuntary Treatment of the
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Mentally Ill in Iowa: The 1975 Legislation, 61 Iowa L. Rev. 262, 290 (1975)
[hereinafter Bezanson]. According to Professor Bezanson’s analysis:
The emotional-injury provision manifests a feeling that
“physical injury” defines too narrow a category of behavior for
purposes of enforced treatment, for often the most serious
consequences of mental disorder are emotional. Accordingly, the
statute provides that where truly serious emotional consequences
result for family members or others who are not able to avoid them,
enforced treatment may be ordered.
Id.
J.K. contends nothing in the record shows she “has ever done, or was
ever likely to do, anything that could cause a diagnosable emotional injury in
anyone, and in particular to anyone not reasonably able to avoid contact with
her.” J.K. argues her mother could choose to avoid contact with her, but her
mother instead testified she goes out of her way to maintain contact with her
daughter. J.K. further argues nothing in the record supports a finding that such
harm would rise “to the level of severity necessary to satisfy the element of the
section 229.1(17) definition of serious mental impairment.”
In response to J.K.’s argument concerning the endangerment element, the
State points to T.G.F.’s anguished testimony that her daughter has been isolated
from her family by her much-older boyfriend, is a victim of human trafficking, and
needs “trauma-based” therapy. T.G.F. wrote to the court that she was “a deeply
concerned mother” and fears for her daughter’s safety. The State urges: “This
mom wants her daughter to stop prostituting herself, stop exotic dancing and
stop using drugs. Her frequent correspondence with the court is an indication of
the emotional toll this is taking on her.”
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We do not question T.G.F’s credibility or her heart-felt concern for her
daughter. And it is entirely understandable and commendable that T.G.F.
desires to maintain contact with her troubled nineteen-year-old daughter. But the
“emotional toll” described by the State resulting from that ongoing contact does
not meet the standard of “serious emotional injury” that can be “recognized and
diagnosed” by a mental health professional under the statute. See J.P., 574
N.W.2d at 344 (reasoning that “emotional trauma” did not rise to the level of
“serious emotional injury”). Neither does the State identify any recent overt acts
by J.K. that signal she is likely to inflict serious emotional injury on family
members or others who lack reasonable opportunity to avoid contact with her.
See Bezanson, 61 Iowa L. Rev. at 295 (“Generalized predictions of emotional
stress without accompanying manifestations drawn from the past should not
suffice under the clear and convincing evidence standard.”). Professor
Bezanson further explained the legislative standard:
Emotional injury is not precisely delineated, but it would include, for
example, serious disruption of family relations leading to
depression or nervous breakdown of family members, physical
violence on the part of others, or medically diagnosable
complications. In each case, however, the injury must be caused
by the respondent as a result of his or her mental illness. . . . The
injured party, whether a member of the respondent’s family or not,
must “lack reasonable opportunity to avoid contact with” the
respondent. Thus, an individual’s unreasonable self-subjection to
the respondent and resulting emotional injury will not support a
finding of emotional injury under the statute.
Id. at 302.
We conclude the State failed to offer clear and convincing evidence to
satisfy the serious-emotional-injury prong of section 229.1(17)(b). Accordingly,
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we reverse the district court’s order declaring J.K. to be seriously mentally
impaired.
REVERSED.