Opinion
No. 5-586 / 04-1859
Filed August 17, 2005
Appeal from the Iowa District Court for Scott County, Bobbie Alpers, Judge.
A respondent appeals from the district court ruling that found her to be seriously mentally impaired and placed her on out-patient commitment. AFFIRMED.
Jack Dusthimer, Davenport, for appellant.
Willaim E. Davis, County Attorney, and Theodore Priester, Assistant County Attorney, for appellee.
Considered by Huitink, P.J., and Vogel and Zimmer, JJ.
E.S. appeals from the district court ruling that found her to be seriously mentally impaired and placed her on an out-patient commitment. Our review of this involuntary civil commitment proceeding, triable as a civil matter, is for the correction of errors at law. Iowa Code § 229.12(3) (2003); Iowa R. App. P. 6.4. Upon such review, we conclude the district court should be affirmed.
Before a person may be involuntarily committed, there must be clear and convincing evidence that he or she has a serious mental impairment. See Iowa Code § 229.13(1); In re J.P., 574 N.W.2d 340, 342 (Iowa 1998). Serious mental impairment requires proof that E.S. has a mental illness, that as a result of the mental illness she lacks sufficient judgment to make responsible decisions with respect to her hospitalization or treatment, and that due to the mental illness she meets at least one 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.
In this case, the district court concluded that E.S. suffered from the mental illness of schizophrenia, was not capable of making sound decisions regarding hospitalization and treatment, and that E.S.'s failure to take her anti-psychotic medication resulted in conduct that presented a danger to herself or others. The court noted that E.S.'s mental health had improved since her initial hospitalization, but concluded the improvement was due to enforced medication. The court further concluded that E.S. had no understanding of her need for medication, and that without administered medication E.S. would become psychotic and pose an imminent danger to herself and others. The court accordingly ordered E.S. placed on an out-patient commitment and directed her to cooperate in treatment. E.S. appeals from this order.
On appeal E.S. asserts there was not clear and convincing evidence that she was seriously mentally impaired. She does not dispute the fact that she suffers from a mental illness or that there was clear and convincing evidence to support the court's determination that she lacked sufficient judgmental capacity to make responsible decisions regarding her hospitalization and treatment. She contends, however, that the court was not presented with clear and convincing evidence she was a danger to herself or others if allowed to remain at liberty without treatment. The district court's finding in this regard is binding upon us so long as it is supported by substantial evidence. J.P., 574 N.W.2d at 342. "Evidence is substantial if a reasonable trier of fact could conclude the findings were established by clear and convincing evidence." Id.
E.S. also asserts the district court erred in continuing her involuntary commitment because the record revealed she no longer suffered from the "same level of serious mental illness" she suffered from at the time of the initial hospitalization. She cites to the case of B.A.A. v. University of Iowa Hosps., 421 N.W.2d 118 (Iowa 1988), in support of her contention. However, B.A.A. stands for no more than the proposition that the court cannot continue involuntary commitment unless the respondent continues to meet the definition of "seriously mentally impaired" under § 229.1(15). B.A.A., 421 N.W.2d at 125-26. The only question before the district court was whether E.S. presently met the statutory definition; the relative level of her impairment was of no consequence. See id. at 125 ("[t]he statute requires a respondent's serious mental impairment be established as of the time of the decision to commit rather than at some earlier point. This is true not only with respect to the initial treatment decision, but also for each of the subsequent re-determinations. . . . The standards applicable at each step are the same; at each point the question relates to the respondent's present, not past, condition." (citation omitted)). Accordingly, the only issue that need by addressed on appeal is whether there is substantial evidence to support the district court's findings.
The court did not specify which of the three "dangerousness" alternatives it found to be established in this case. However, based upon the record and the language of the court's ruling, it appears the district court found the record contained clear and convincing evidence that E.S. was likely to physically injure herself or others if allowed to remain at liberty without treatment.
The record contains little if any evidence which would support a finding that, because of her mental illness, E.S. was likely to cause serious emotional injury to others or was unable to provide for her basic needs.
The danger E.S. poses to herself or others must be evidenced by a "recent overt act, attempt or threat." J.P., 574 N.W.2d at 344 (citation omitted). Socially unacceptable, even repugnant, behavior does not satisfy the overt act requirement. In re Mohr, 383 N.W.2d 539, 542 (Iowa 1986). "[A]n `overt act' connotes past aggressive behavior or threats by the respondent manifesting the probable commission of a dangerous act upon [her]self or others that is likely to result in physical injury." In re Foster, 426 N.W.2d 374, 378 (Iowa 1988). Verbalized delusions, even though bizarre, do not constitute the type of overt act necessary to establish dangerousness. See id. at 379.
Here, the civil commitment proceedings were commenced by E.S.'s daughters, J.M. and O.M. In their affidavits in support of an order of involuntary hospitalization, they asserted E.S. had stopped taking her medication; "has been running around nude"; was making "strange" and "inappropriate" statements, such as accusing her daughters of using their "`supernatural' powers to play in her vaginal area"; was rubbing olive oil on her neighbors' doors "to keep the demons inside" and accused the neighbors of "doing witch craft (sic) on her"; was arrested for throwing plates at passing cars, while naked and covered in cooking grease; took O.M.'s two-year-old son to New York without O.M.'s knowledge or consent; and while walking on a bike trail hit a man's dog in the head with a stick, saying the animal was "possessed with demons."
The district court heard testimony from Dr. John Ciaccio, who had treated E.S. for the previous one to one and a half years. Dr. Ciaccio testified that, around the time of the commitment proceedings, E.S. became "more psychotic," and that when she was admitted to the hospital she was "very agitated and aggressive . . . [and] had potential for violence." Although Dr. Ciaccio did not have firsthand knowledge regarding whether E.S. had been taking her daily anti-psychotic medication prior to commitment, he did testify that once he began administering her medication via monthly injections E.S. began "doing much better."
Dr. Ciaccio testified that E.S. had been moved to an out-patient status, which required E.S. to meet with Dr. Ciaccio on a regular basis and receive an anti-psychotic medication injection once a month. Dr. Ciaccio opined that if the out-patient commitment did not continue E.S. would cease compliance with the monthly injections and would again deteriorate into a psychotic state. His opinion was based upon a past history of noncompliance with her medication. Dr. Ciaccio further opined that without regular medication E.S. would be a danger to herself or others. He cited many of the incidents E.S.'s daughters had reported in their affidavits.
E.S. also testified. She asserted that she had been compliant with her medication. She contended that a doctor had told her grease was an inexpensive moisturizer. While she admitted taking her grandson to New York, she asserted she had left her daughter a message. When asked about the dog incident, E.S. asserted she was carrying the stick in case a dog tried to attack her. She explained: "I had started carrying a stick just to warn them [dogs] off. . . . I thought they were demons. I didn't want to get bit by a dog. . . ."
We conclude the foregoing provides substantial evidence in support of the court's finding of serious mental impairment. Although E.S. attempted to explain away much of her behavior, the district court did not find her testimony convincing. Moreover, while E.S. contends there is no proof of a recent overt act, we believe impulsively taking a two-year-old child out of state without parental permission, striking a dog with a stick, and throwing plates at passing cars are recent overt acts that evidence a likelihood E.S. will pose a physical danger to herself or others if allowed to remain at liberty without treatment. See In re Oseing, 296 N.W.2d 797, 801 (Iowa 1980) (explaining predictive nature of dangerousness element). We affirm the district court's ruling.
While E.S. contends much of the evidence is no more than unsubstantiated hearsay, in an involuntary civil commitment proceeding "[t]he court shall receive all relevant and material evidence which may be offered and need not be bound by the rules of evidence." Iowa Code § 229.12(3).