IN THE COURT OF APPEALS OF IOWA
No. 19-2044
Filed November 30, 2020
IN THE MATTER OF R.B.,
Alleged to Be Seriously Mentally Impaired,
R.B.,
Respondent-Appellant.
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Appeal from the Iowa District Court for Marshall County, James A. McGlynn,
Judge.
R.B. appeals the district court’s refusal of R.B.’s petition for a writ of habeas
corpus. AFFIRMED.
John L. Dirks of Dirks Law Firm, Ames, for appellant.
Thomas J. Miller, Attorney General, and Gretchen Kraemer, Special
Assistant Attorney General, for appellee State.
Considered by Vaitheswaran, P.J., and Tabor and Schumacher, JJ.
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VAITHESWARAN, Presiding Judge.
R.B. was found to have a “serious mental impairment.” See Iowa Code
§ 229.1(20) (2019). He was placed at the Iowa Veterans Home in Marshalltown,
Iowa. The court of appeals affirmed the placement in In re R.B., No. 15-0823,
2015 WL 6507836, at *1 (Iowa Ct. App. Oct. 28, 2015).
Approximately four years after our opinion was filed, R.B. petitioned for a
writ of habeas corpus. See Iowa Code § 229.37 (“All persons confined as seriously
mentally impaired shall be entitled to the benefit of the writ of habeas corpus, and
the question of serious mental impairment shall be decided at the hearing.”).
Following an evidentiary hearing, the district court “refused” the writ. R.B.
appealed.
“Serious mental impairment” describes “the condition of a person with
mental illness” who, “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”:
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.
d. Has a history of lack of compliance with treatment and any
of the following apply:
(1) Lack of compliance has been a significant factor in
the need for emergency hospitalization.
(2) Lack of compliance has resulted in one or more acts
of serious physical injury to the person’s self or others or an attempt
to physically injure the person’s self or others.
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Id. § 229.1(20). “The continuation of an involuntary commitment requires the same
impairment as ascribed to it by section 229.1[(20)], although reviewed in habeas
corpus proceedings pursuant to section 229.37.” In re B.T.G., 784 N.W.2d 792,
796 (Iowa Ct. App. 2010) (citation omitted).
R.B. focuses on subsection 229.1(20)(a). He argues the court improperly
“concluded he is likely to injure himself or others if released from the civil
commitment.” We review “the propriety of continued involuntary commitment” for
errors of law. B.A.A. v. Univ. of Iowa Hosps., 421 N.W.2d 118, 120 (Iowa 1988).
“The district court’s findings of fact are binding upon this court if supported by
substantial evidence.” B.T.G., 784 N.W.2d at 796.
The district court made the following pertinent findings: “First, the
respondent continues to have a multi-faceted mental health diagnosis which
requires structure and medication to keep him safe. Second, the respondent’s
traumatic brain injuries cannot be treated or reversed. Third, the respondent has
recently demonstrated that he is unable to control his impulse to consume alcohol.”
The court summarized the testimony of R.B.’s psychiatrist, citing R.B.’s mental-
health diagnoses, “history of substance abuse and alcoholism,” history “of
traumatic brain injuries,” and “a serious fall after drinking” that required a “lengthy
hospitalization and treatment.” The court found the psychiatrist’s testimony
“convincing.” The court next described an episode that occurred during a furlough
with R.B.’s family, finding that, “[a]t some point during the furlough, [R.B.] was left
alone . . . for a period of about one-half hour;” and, “[d]uring that period, [he]
consumed an estimated 11 beers.” The court determined:
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[R.B.’s] history of falling, the emergency treatment and lengthy
hospitalization resulting from his head injuries and the lack of impulse
control shown by the failed visit with [his] family show that he is likely
to physically injure himself if allowed to remain at liberty without
treatment. His history of lack of compliance with treatment has
resulted in the need for emergency hospitalization and resulted in
one or more acts of serious physical injury to [himself].
The court’s findings are supported by substantial evidence. Specifically, the
psychiatrist described R.B.’s bouts of drinking during two furloughs, then opined,
“He does show a definite loss of impulse control when it comes to his drinking.”
He spoke to the dangers of R.B.’s alcohol use as follows:
I think it’s dangerous on many levels. It may exacerbate his tendency
to be aggressive or violent, which I think stems mainly from his
antisocial personality disorder, as well as his brain injury which
reduces his ability to control impulses. I think alcohol would make
those behaviors even worse. Also I think it could cause further
cognitive impairment or cognitive or brain damage for him if he
continued to drink, and I think that alcohol would put him at risk for
falls which could result in additional brain damage if he struck his
head.
The psychiatrist was unpersuaded that R.B.’s willingness to take Antabuse would
control his drinking. He testified, “There are many people who have this lack of
impulse control who will just simply drink and experience the consequences of
Antabuse, but still just push through that and continue to drink.” See In re B.B.,
No. 04-1886, 2005 WL 1225959, at *3 (Iowa Ct. App. May 25, 2005) (finding B.B.
was a danger to himself based on a recent fall due to alcohol dependency and his
continued neglect of self-care). As for R.B.’s compliance with his existing
medication regimen, the psychiatrist testified:
[R.B] has been compliant with his medication in this setting. My
concern is that particularly if he started drinking, that he would very
quickly stop the medication. I don’t think he’s opposed to taking it,
but I think he would not have that structure of someone giving him
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the medication and monitoring it. And without that, I think it would
become unimportant to him and he would very quickly stop doing it.
He opined that, without one of the medications, R.B.’s “psychotic symptoms,
his delusions and hallucinations would be worse” and, without two others, “his
aggression could become worse.” The delusions, the psychiatrist stated, might
cause R.B. to “journey out to California,” a prediction grounded in R.B.’s testimony
that he wished to do just that, notwithstanding his lack of a valid driver’s license.
Notably, R.B. did not attend follow-up visits with the psychiatrist even in the
supervised VA setting, lending credence to the psychiatrist’s concern about his
ability to independently manage his medication regimen. Because the district
court’s findings are supported by substantial evidence, we conclude the court did
not err in ordering R.B.’s continued placement.
In reaching this conclusion, we recognize that other record evidence
supports R.B.’s assertion that he did not pose a danger to himself. For example,
the psychiatrist conceded R.B. had freedom to come and go into town and he
remained sober during those outings.
We also recognize the State was obligated to prove R.B. committed a recent
overt act establishing dangerousness and the family furlough during which R.B.
consumed eleven beers in thirty minutes occurred close to a year before the
habeas corpus hearing. See In re L.H., 890 N.W.2d 333, 341 (Iowa Ct. App. 2016)
(finding the “recent overt act” requirement was not satisfied where “the last overt
act occurred . . . nearly one year before [the] placement review”). But the record
of dangerousness in L.H. was thin. The “State offered no testimony or other
evidence at the perfunctory [initial] hearing” and, on appeal to the district court,
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which held a “de novo trial,” the State apparently declined to call the treating
psychiatrist as a witness. See id. at 336–37, 340. Here, in contrast, the treating
psychiatrist thoroughly explained his reasons for believing R.B. posed a danger to
himself. See In re J.R., No. 17-0449, 2018 WL 2084819, at *2 (Iowa Ct. App. May
2, 2018) (citing testimony of same psychiatrist and stating “[a]lthough [certain]
behaviors are not currently occurring and have not occurred in some time, the
evidence shows they are likely to occur again if [the] commitment was not
continued”).
We affirm the district court’s denial of R.B.’s petition for writ of habeas
corpus.
AFFIRMED.