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In re L.J.

Court of Appeal of Iowa

October 2, 2013


Appeal from the Iowa District Court for Johnson County, Marsha M. Beckelman, Judge.

L.J. appeals the district court's ruling affirming the finding L.J. is seriously mentally impaired.

Frank Santiago, Iowa City, for appellant.

Thomas J. Miller, Attorney General, and Gretchen Witte Kraemer, Assistant Attorney General, Janet M. Lyness, County Attorney, and Susan Nehring, Assistant County Attorney, for appellee State.

Considered by Vogel, P.J., and Danilson and Tabor, JJ.


L.J. appeals from the district court's order finding L.J. is seriously mentally impaired and thus subject to civil commitment, pursuant to Iowa Code section 229.1(17) (2011). L.J. claims the allegations and subsequent court rulings are not supported by clear and convincing evidence. Because we find the State's expert provided clear and convincing evidence L.J. is seriously mentally impaired, we affirm.

I. Factual and Procedural Background

L.J., born in 1993, is currently an inmate at the Iowa Medical and Classification Center (IMCC), before which he was serving time at the Anamosa State Penitentiary. When he first arrived an Anamosa, L.J. was seen periodically by psychologists and was diagnosed with anti-social disorder and prescribed medication for anxiety, impulsiveness, and problems with sleep. However, after a brief period of time, L.J. refused the medication, and his agitation and disruptive behaviors increased. After serving less than one year, L.J. accumulated almost eighteen months of disciplinary time for actions such as threatening staff, being off unit, and assaulting his cellmate. Consequently, on November 9, 2012, L.J. was transferred to the IMCC. Once there, L.J. informed staff he could drown himself by using a toilet or could use a light fixture to electrocute himself. These comments prompted staff to put L.J on suicide watch.

Gary Keller, D.O., conducted an initial examination of L.J. on November 9, 2012, in which he diagnosed L.J. with mood disorder not otherwise specified (NOS), learning disorder NOS, and mild mental retardation. After this examination, Dr. Keller wrote a letter informing the court of his intention to file for a civil commitment of L.J. due to L.J.'s psychiatric disorders and the danger he posed to himself and others. Dr. Keller characterized L.J.'s behavior as "explosive and impulsive . . . [and that has] put staff and ultimately [L.J.] in danger . . . ." Cleo Hester, a social worker at the IMCC, filed the application for order of involuntary hospitalization on November 13, reflecting Dr. Keller's conclusion.

On December 1, 2012, an independent medical examination was performed by Christopher Okiishi, M.D., who interviewed L.J. in person and also reviewed Dr. Keller's and Hester's reports. Dr. Okiishi concluded that, though L.J. has a mental illness, L.J. was not a danger to himself or others at the time, and therefore should not be civilly committed. Based on this report, L.J. filed a motion to dismiss, which was denied.

On December 14, 2012, a hearing was held before the judicial hospitalization referee. In his physician's report of examination, composed pursuant to Iowa Code section 229.10(2), Dr. Keller stated that after a more thorough examination, he concluded L.J. suffers from bipolar disorder NOS, with concerns of hypomanic periods and intermittent explosive disorder, and borderline intellectual functioning. Dr. Keller further noted L.J.'s loud and disruptive behavior and denial of any need for medication. The hospitalization referee granted the application for involuntary commitment.

L.J. then filed a notice of appeal and a de novo hearing was held in district court on December 31. Dr. Keller testified, reiterating his opinion as set forth in his December 14 physician's report to the court. He further testified L.J. was recently returned to the acute psychiatric unit after engaging in actions indicating he would harm himself, and was again placed on suicide watch. However, after beginning a new medication regimen, L.J.'s violent and disruptive behavior had lessened, though at the time of the hearing L.J. had only been on the new medication for two weeks. In its order, the court found Dr. Keller's testimony regarding L.J.'s serious mental impairment credible, and furthermore, after listening to and observing L.J. testify, found:

[L.J.] demonstrated little or no insight into his mental health problems . . . . [L.J.] demonstrated that he is unable to manage his mental illness on his own at this time. Even though he responds to treatment with medication, without the benefit of a more structured environment, it is highly likely that [L.J.] will not make decisions as are in his best interest. [L.J.] has a history of being noncompliant with taking prescribed medications . . . . The Court agrees with Dr. Keller that [L.J.] presents a danger to himself and others due to his history of refusing to be ...

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