In the Matter of J.R., Alleged to be Seriously Mentally Impaired , 919 N.W.2d 635 ( 2018 )

IN THE COURT OF APPEALS OF IOWA
No. 17-0449
Filed May 2, 2018
IN THE MATTER OF J.R.,
Alleged to be Seriously Mentally Impaired.
J.R.,
Respondent-Appellant.
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Appeal from the Iowa District Court for Marshall County, Timothy J. Finn,
Judge.
J.R. appeals the order denying his writ of habeas corpus to vacate and set
aside his involuntary commitment. AFFIRMED.
Merrill C. Swartz of Swartz Law Firm, Marshalltown, for appellant.
Thomas J. Miller, Attorney General, and Gretchen W. Kraemer, Assistant
Attorney General, for appellee State.
Considered by Tabor, P.J., McDonald, J., and Carr, S.J.*
*Senior judge assigned by order pursuant to Iowa Code section 602.9206 (2018).
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CARR, Senior Judge.
J.R. has been under commitment as a person with a serious mental
impairment since 2004. In 2012, this court affirmed an order continuing his
commitment. See In re J.R., No. 11-1180, at *1 (Iowa Ct. App. Feb. 15, 2012).
J.R. now appeals the order denying his writ of habeas corpus to vacate and set
aside his involuntary commitment. See Iowa Code § 229.37 (2016) (stating that a
person who is confined for serious mental impairment may challenge continued
involuntary commitment by writ of habeas corpus). He contends there is
insufficient evidence that he is seriously mentally impaired.
We review claims relating to the sufficiency of the evidence in involuntary
commitment proceedings for errors at law. See In re B.B., 826 N.W.2d 425, 428
(Iowa 2013). The burden of proving serious mental impairment is by clear and
convincing evidence. See 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.” Id. (citation omitted). The district court’s
finding that J.R. is seriously mentally impaired is binding on us if supported by
substantial evidence. See Iowa R. App. P. 6.904(3)(a). “Evidence is substantial if
a reasonable trier of fact could conclude the findings were established by clear and
convincing evidence.” In re L.H., 890 N.W.2d 333, 339 (Iowa 2016) (citation
omitted).
The court’s inquiry in a habeas corpus proceeding is the same as in an
original commitment order under chapter 229 for someone who is seriously
mentally impaired. See B.A.A. v. Chief Med. Officer, Univ. of Iowa Hosps. &
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Clinics, 421 N.W.2d 118, 125 (Iowa 1988). Chapter 229 defines “seriously
mentally impaired” or “serious mental impairment” as
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:
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.
Iowa Code § 229.1(20).
J.R. has been diagnosed with schizophrenia and obsessive compulsive
disorder. He does not dispute the finding that he is a person with mental illness.
He instead argues the evidence does not support the district court’s findings that
he lacks sufficient judgment to make responsible decisions as to his treatment and
that he is likely to injure himself or others if allowed to remain at liberty without
treatment.
The evidence presented at the hearing came primarily from Dr. Douglas
Steenblock, who is board certified in psychiatric medicine and has been treating
J.R. for more than ten years. Dr. Steenblock opined that J.R. is still seriously
mentally impaired and, if not under commitment, J.R. would not provide proper
care for himself and would be likely to injure himself or others.
J.R. argues the district court reached its finding that he presents a danger
to himself or others based on acts that occurred in or around 2010. Dr. Steenblock
testified as to these acts to explain J.R.’s behavior when not taking medication.
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Dr. Steenblock testified that J.R. now takes an antipsychotic medication that
alleviates many of the symptoms of schizophrenia. However, before J.R. began
taking the medication, Dr. Steenblock observed that J.R. showed many positive
psychotic symptoms and that his behavior was escalating. Dr. Steenblock testified
that prior to his commitment, J.R. “was very angry and irritable,” made “statements
that implied that he might assault someone if they provoked him,” and made
specific threats to individuals based on his paranoid beliefs that they were trying
to harm him. In addition to his violent propensities, Dr. Steenblock explained that
when J.R. was not taking antipsychotic medication, there “was concern that he
was losing weight and malnourished. His hygiene was extremely poor. He refused
medical interventions like physical examinations or laboratories.”
Although J.R. has not exhibited the symptoms that made him a threat to
himself or others since he began taking his medication, Dr. Steenblock explained
that J.R.’s symptoms would return if he stopped taking the medication. Dr.
Steenblock explained that J.R.’s obsessive compulsive disorder causes recurrent
obsessions about his medication, which negatively affects J.R.’s willingness to
take it. Based on past experiences, Dr. Steenblock testified that if J.R. were to
stop taking his medication, “within a short time he would revert back to his previous
state of being very delusional and probably quite agitated. And I think this would
not only result in potential aggressive behavior but also a lot of self-neglect.”
Although these behaviors are not currently occurring and have not occurred in
some time, the evidence shows they are likely to occur again if J.R.’s commitment
was not continued. As Dr. Steenblock opined, “[I]f [J.R.] was no longer compelled
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by the court to participate in treatment and take medication, I am certain he would
become a danger to himself or others.”
J.R. also notes that Dr. Steenblock testified J.R. is not a threat to himself or
others while he is taking his medication. However, J.R. testified at the hearing that
if he was not under commitment, he would discontinue taking his medication. This
statement of intent is evidence of both a lack of judgment and of a current overt
act supporting the proposition he is a current danger to himself or others if not
under commitment and so required to take his medication. See In re Mohr, 383
N.W.2d 539, 542 (Iowa 1986). Although J.R. cites potential side effects as a
reason to stop taking his medication, the hospital closely monitors these side
effects.
Dr. Steenblock provided ample evidence that J.R. lacks the necessary
judgment to make responsible decisions with respect his treatment and that he
would be a danger to himself or others if he was no longer under commitment.
Because substantial evidence supports the court’s finding that J.R. is seriously
mentally impaired, we affirm the order denying J.R.’s writ of habeas corpus.
AFFIRMED.