In the Matter of S.M. ( 2018 )

IN THE COURT OF APPEALS OF IOWA
No. 17-1591
Filed March 7, 2018
IN THE MATTER OF S.M.,
Alleged to be Seriously Mentally Impaired,
S.M.,
Respondent-Appellant.
________________________________________________________________
Appeal from the Iowa District Court for Johnson County, Chad A. Kepros,
Judge.
An inmate diagnosed with schizophrenia appeals the district court order
finding him to be seriously mentally impaired under Iowa Code chapter 229 (2017).
AFFIRMED.
Sandra R. Hart of Hart Law, North Liberty, for appellant.
Thomas J. Miller, Attorney General, and Gretchen W. Kraemer, Assistant
Attorney General, for appellee State.
Considered by Doyle, P.J., and Tabor and McDonald, JJ.
2
TABOR, Judge.
Convicted of first-degree murder nearly forty years ago, S.M. is serving a
life sentence in the custody of the Iowa Department of Corrections (DOC). S.M.
has been treated for schizophrenia during his prison stay. From 2000 until 2016
he was subject to a civil commitment order as a means to enforce medication
compliance. Without that enforcement, S.M. resisted taking his prescribed anti-
psychotic drug and grew increasingly delusional. When S.M.’s conspiracy theories
progressed to include prison staff and other inmates, and he discussed “retaliation”
against them, his treating psychiatrist sought to renew the civil commitment. The
district court ordered S.M. to receive treatment within the DOC at the outpatient
level of care. S.M. appeals that order, contending the State did not prove he posed
a danger. In light of his past actions, S.M.’s current threats and physical posturing
signaled the probable commission of a harmful act upon himself or others likely to
result in physical injury; we find the dangerousness element satisfied.
I. Facts and Prior Proceedings
S.M.’s diagnosis of schizophrenia dates back to 1977 when he was
discharged from the military. S.M. admitted killing his mother in 1978 by striking
her head with a large concrete lawn ornament. At his trial, S.M. claimed he
suffered from a psychosis aggravated by drug and alcohol use. He nevertheless
received a sentence of life without parole. Early in his prison term, around 1984,
S.M. engaged in self-mutilation, cutting his testicles with a razor. He also got into
two fights with fellow inmates during the 1980s. He attempted suicide in the late
1990s. The DOC records indicate S.M. has exhibited ongoing delusions and
fixations involving “biker gang wars” and “rock and roll wars,” as well as conspiracy
3
theories about murders across the country. At times, his delusions have been
categorized as hyper-sexual and hyper-religious, including his declaration of a
“holy war” in which he was the leader of his own church.
DOC psychiatrist Gary Keller noted S.M. had “a long history of not
complying with medications and treatment, so had been on a long acting injectable
medication, haloperidol, for many years.” Because of his non-compliance, from
2000 until 2016, S.M. was under a mental health civil commitment at the Clarinda
Correctional Facility, where he was incarcerated. In May 2017, the DOC
transferred S.M. back to the Iowa Medical and Classification Center (IMCC) so that
his mental illness could be better monitored and managed. According to Dr. Keller,
since the commitment ended, S.M. “has refused his medication for treatment of his
schizophrenia” and “has deteriorated in regard to his delusional system.” Dr. Keller
found S.M.’s illness has grown “much more prominent in his interactions.”
In early August 2017, S.M. became convinced a corrections officer on his
unit, as well as other inmates, were involved in a conspiracy involving the death of
S.M.’s father. While on the prison yard, staff overheard S.M. discussing the
conspiracy and bringing up “retaliation.” S.M. also spoke of a “genocide scenario.”
In the same time period, S.M. wrote a note discussing his father’s death which,
according to Dr. Keller’s recollection, stated “quote, they should pay for what
they’ve done.” S.M. named a particular offender in the note and also
“incorporated” officers in S.M.’s living unit and acute mental health unit into his
conspiratorial thinking. In a follow-up discussion with Dr. Keller, S.M. engaged in
“even more delusional talk.” Meanwhile, fellow inmates expressed unease about
S.M.’s compulsive pacing and his aggressive demeanor. Dr. Keller also received
4
reports S.M. displayed “increased irritability” and intimidated other inmates when
he “often flexes and tenses up in mannerisms as if he is ready to strike out.” Dr.
Keller opined S.M. was “starting to act on his delusional thinking.”
Dr. Keller feared not only for the inmates and staff who came in contact with
S.M. at the prison but also was concerned that S.M.’s manifestations of his
schizophrenia were threatening S.M.’s own health. S.M. would exercise to the
point of developing sores on his hands and feet and allowed his personal hygiene
to decline. S.M. also was reluctant to rehydrate because he believed the water at
the prison was contaminated. According to Dr. Keller, S.M. was not only refusing
his anti-psychotic medication, but S.M.’s compliance with taking other prescribed
medications for physical maladies had waned.
On August 7, 2017, a social worker at the IMCC filed an application for an
order of involuntary hospitalization with S.M. as the respondent. Dr. Keller filed a
physician’s report outlining his concerns about S.M.’s mental health and increasing
threats toward staff and fellow inmates. After a hearing, a judicial hospital referee
found S.M. to be seriously mentally impaired within the meaning of Iowa Code
chapter 229 (2017). S.M. appealed and the district court held a hearing on
September 12, 2017. Dr. Keller testified that the point of the mental-health
commitment was to enable staff to administer medication notwithstanding S.M.’s
objection. Dr. Keller said S.M. had “incorporated” different officers on the living
unit and on the acute mental-health unit into his conspiracy theories. Plus, peers
indicated they were concerned about S.M.’s demeanor and avoided interactions
with him. S.M. also testified, telling the court he “doesn’t believe [he] is
5
schizophrenic.” S.M. testified he dislikes the side effects of the anti-psychotic
medication, which makes him lethargic, shaky, and restless.
The district court affirmed the finding of the judicial hospitalization referee,
noting that during S.M.’s testimony “he quickly reverted to the delusional and
conspiratorial thinking that Dr. Keller had described in his testimony. The Court
agrees with Dr. Keller that [S.M.] represents a danger to himself and others at this
time due to his mental illness.” S.M. appeals the district court’s findings.
II. Scope and Standards of Review
We review challenges to the sufficiency of the evidence in involuntary
commitment proceedings for the correction of legal error. In re B.B., 826 N.W.2d
425, 428 (Iowa 2013). The State must prove an allegation of serious mental
impairment by clear and convincing evidence. Iowa Code § 229.13(1). “Clear and
convincing evidence is less burdensome than evidence establishing proof beyond
a reasonable doubt, but more burdensome than a preponderance of the evidence.”
B.B., 826 N.W.2d at 428. Clear and convincing proof leaves “no serious or
substantial doubt about the correctness of a particular conclusion drawn from the
evidence.” Id. (quoting In re J.P., 574 N.W.2d 340, 342 (Iowa 1998)). The district
court’s factual findings are binding on us if they are supported by clear and
convincing evidence. J.P., 574 N.W.2d at 342.
III. Analysis of Endangerment Component
Involuntary hospitalization requires proof of a “serious mental impairment.”
See Iowa Code §§ 229.1(20), 229.6(2)(a)(2), 229.13(1). The code defines “serious
mental impairment” as:
6
[T]he 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 . . . [i]s likely to physically injure the person’s
self or others if allowed to remain at liberty without treatment.
Id. § 229.1(20)(a). Only the last element, commonly referred to as the
endangerment component, is at issue in this appeal.
Proving endangerment requires “predictive judgment” that is built on “prior
manifestations” but focuses on future rather than past danger. In re Mohr, 383
N.W.2d 539, 542 (Iowa 1986). To deprive a person of their liberty through civil
commitment, the State must show the person poses a danger to himself or
others—evidenced by a “recent overt act, attempt or threat.” Id. (quoting Stamus
v. Leonhardt, 414 F.Supp. 439, 451 (S.D. Iowa 1976)). Our supreme court has
held in the context of civil commitment that 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).
S.M. argues the recent threats of “retaliation” attributed to him were too
lacking in detail to show the likelihood that he would cause physical injury to
another person. He contends writing down “they will pay” did not manifest a direct
threat toward another inmate or prison staff. S.M. also insists his overt acts did
not demonstrate he was likely to injure himself.
S.M. correctly points out that “socially unacceptable, even repugnant
behavior” is not enough to satisfy the endangerment element. See Mohr, 383
N.W.2d at 542. Likewise, spouting bizarre delusions—without more—does not
qualify as a recent over act. Foster, 426 N.W.2d at 379.
7
But the district court was allowed to view S.M.’s repulsive behavior and
bizarre delusions in the context of the overall course of his schizophrenia. While
S.M.’s murder of his mother, attempts at suicide and self-harm, and history of
physical altercations with other inmates occurred years ago, they still provide a
backdrop for his current threats. See United States v. Mikawa, 849 F.3d 445, 451
(8th Cir. 2017) (noting committed person’s assault of his first wife was entitled to
less weight because it occurred over twenty-five years ago but “need not be
entirely discounted” (citing United States v. Evanoff, 10 F.3d 559, 563 (8th Cir.
1993) (“[T]he recency or remoteness of any particular activity simply affects the
weight the court will give to that particular evidence.”))); see also Mohr, 383 N.W.2d
at 542 (noting attack involving Mohr’s father occurred many years ago but Mohr’s
presently expressed view of it is was “ominous” and portrayed “a sadly twisted
frame of mind” and holding “[w]ith this background his sexual overtures to total
strangers and his fantasies about sexual attacks take on a threatening nature”).
Given S.M.’s violent past, his recent delusions and threats implicating other
inmates and prison staff were sufficient to prove dangerousness even if he did not
have the opportunity to act on them. See United States v. S.A., 129 F.3d 995,
1001 (8th Cir. 1997) (“The violent nature of S.A.’s visual and auditory hallucinations
and his actual prior violent behavior are sufficient to support a finding that he is
dangerous.”). Even without action, S.M.’s physical posturing and aggressive
stances made his fellow inmates nervous.
We likewise find no error in the district court’s conclusion S.M’s recent overt
acts demonstrate a likelihood he would injure himself if not civilly committed.
Beyond his threats to seek retribution against others, the record showed S.M. was
8
exercising to the point of injury, not drinking water, not regularly showering, and
not taking prescribed medication for physical ailments. See generally In re B.T.G.,
784 N.W.2d 792, 798 (Iowa Ct. App. 2010) (finding substantial evidence to
establish that inmate was likely to injure himself or others physically because of
his mental illness when he threatened to harm prison staff and their children and
was striking out at the walls and door of his cell).
The record contains substantial evidence to support the district court’s
conclusion S.M. has a serious mental impairment. In particular, we find clear and
convincing proof S.M. is likely to injure himself or others if allowed to remain at
liberty without treatment.
AFFIRMED.