In the Matter of A.R., Alleged to Be Seriously Mentally Impaired ( 2020 )

IN THE COURT OF APPEALS OF IOWA
No. 18-1325
Filed March 18, 2020
IN THE MATTER OF A.R.,
Alleged to Be Seriously Mentally Impaired,
A.R.,
Respondent-Appellant.
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Appeal from the Iowa District Court for Polk County, Carla T. Schemmel,
Judge.
An appeal from a finding of serious mental impairment. AFFIRMED.
Joel E. Fenton of Law Offices of Joel E. Fenton, PLC, West Des Moines,
for appellant.
Thomas J. Miller, Attorney General, and Gretchen Kraemer, Assistant
Attorney General, for appellee State.
Considered by Bower, C.J., and Greer and Ahlers, JJ.
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BOWER, Chief Judge.
A.R. appeals the district court’s finding of serious mental impairment. A.R.
challenges the sufficiency of the evidence to establish she posed a risk of
emotional or physical danger to herself or others. Finding no reason to disturb the
court’s ruling, we affirm.
“We review challenges to the sufficiency of the evidence in involuntary
commitment proceedings for errors at law.” In re B.B., 826 N.W.2d 425, 428 (Iowa
2013). An allegation of serious mental impairment must be proven by clear and
convincing evidence. Iowa Code § 229.13(1) (2019). “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. “It means that there must be no serious or
substantial doubt about the correctness of a particular conclusion drawn from the
evidence.” Id. (citation omitted).
“[T]o find a person is seriously mentally impaired, that person must first be
found to be ‘afflicted with a mental illness,’ and consequently ‘to lack sufficient
judgment to make responsible decisions with respect to his or her hospitalization
or treatment.’” Id. at 432 (citation omitted). Moreover, the person must be likely,
if allowed to remain at liberty, to inflict physical injury on herself or others or 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.”
Iowa Code § 229.1(20); B.B., 826 N.W.2d at 432. While the elements of serious
mental impairment must be established by clear and convincing evidence, the
district court’s factual findings are binding on appeal if they are supported by
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substantial evidence. 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.
A.R. is a veteran and was previously hospitalized in 2014 for bipolar
disorder. She had also been diagnosed with other mental-health disorders.
In June 2018, A.R. called 911 asking the police for assistance in locating
her husband, claiming he was a prince and she a princess. A.R. stated “incidents
will occur” if the FBI was not called. She had slept three hours in the prior seven
days and was not taking prescribed mental-health medication. The application
alleging serious mental impairment noted, “She continues to state we are not
taking her seriously and something will happen.” Dr. Margo Shultes von
Schlageter’s report upon A.R.’s hospitalization noted “three children in her care
that are not accounted for, not mentioned by patient, possibly in danger due to
neglect.”
When A.R.’s mother and A.R.’s children visited her at the hospital, A.R.
refused to allow her mother to meet with the physician to discuss her condition;
she became “severely irate” and cursed at her mother in front of her children.
Dr. Shultes von Schlageter testified at the hearing that A.R. was diagnosed
with bipolar disorder, the recent episode being manic with psychotic features. On
the date of the doctor’s initial visit with A.R., A.R. was delusional. She also had
been diagnosed in the past with postpartum depression and posttraumatic stress
disorder related to military service.
Q. Is [A.R.] likely to inflict serious emotional injury on family
members or those who lack reasonable opportunity to avoid contact
with her if allowed to remain at liberty without treatment? A. Yes.
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Q. And what recent overt acts or threats do you base that on?
A. This is based on her interactions with her children as well as her
mother.
Q. All right. You had an opportunity to observe that? A. That’s
correct.
Q. And that’s also based upon her mental illness? A. That’s
correct.
Q. . . . Does [A.R.] need to be further evaluated and treated
on an outpatient basis, inpatient was or not at all? A. At this point, if
compelled, she could be treated on an outpatient basis as the least
restrictive order. If, however, she was unable to comply with the
requirements of outpatient treatment, specifically medication and
ongoing appointments with a psychiatrist, then there would exist no
lesser restrictive alternative to inpatient care.
Q. Okay. So the question is, is it likely more than not that she
will not comply with medication and treatment if she’s released?
A. Based on my most recent evaluation of [A.R.], it is likely that she
would not comply with treatment on an outpatient basis if released.
A.R. testified she did not believe she had a mental illness, though she
acknowledged she “had postpartum with psychosis,” which she stated was “in full
remission.” She stated, “I know that I have posttraumatic stress disorder” but “I
don’t think it’s a fair and accurate statement that I’m bipolar.” She added, “I’ve
never been manic” and denied needing medications. However, she also
acknowledged she had been hospitalized for five weeks in the past to “figure out
which [medications] would work for me.”
The district court found that if not committed A.R. was likely to inflict serious
emotional injury on members of her family who lacked reasonable opportunity to
avoid contact with her. There is substantial evidence in the record to support the
district court’s finding. We therefore affirm.
AFFIRMED.