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In re A.S.R.

Court of Appeal of Iowa

October 2, 2013

IN THE MATTER OF A.S.R., Alleged to be Seriously Mentally Impaired A.S.R., Respondent-Appellant.

Appeal from the Iowa District Court for Black Hawk County, George Stigler, Judge.

Respondent appeals decision declaring him seriously mentally impaired.

Nina Forcier of Nydle & Forcier, P.L.L.C., Waterloo, for appellant.

Thomas J. Miller, Attorney General, Gretchen Kraemer, Assistant Attorney General, Thomas J. Ferguson, County Attorney, and Brian Williams, Assistant County Attorney, for appellee.

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


A.S.R. appeals from a district court order continuing his commitment to outpatient treatment under Iowa Code chapter 229 (2013). He argues the involuntary commitment is not supported by evidence showing he is dangerous, or alternatively, that his dangerousness has anything to do with mental illness. We affirm because the record contains clear and convincing evidence A.S.R. suffers from a delusional disorder, and due to that disorder he lacks insight into his condition and poses a danger to others.


On February 14, 2013, Waterloo Police Chief Daniel Trelka filed an application alleging A.S.R., who is forty-nine years old, suffered from a serious mental impairment. In support of his application, Chief Trelka filed an affidavit recounting A.S.R.'s unsettling interactions with city personnel and A.S.R.'s accusations police officers were conspiring against him. The chief reported a February 7, 2013 conversation in which A.S.R. discussed "lining up" those who conspired against him and shooting them. The chief also referenced a written narrative of complaints provided by A.S.R. in which A.S.R. described arming himself with an "H & K 9 mm" when A.S.R. perceived that an Urbandale police detective had given him an intimidating look. Chief Trelka contacted the Urbandale police chief, who confirmed similar erratic behavior by A.S.R. when the respondent was living in Polk County. Chief Trelka's check of Waterloo police records showed A.S.R. had received a permit to acquire a weapon on June 13, 2012, and received a non-professional permit to carry a weapon on February 1, 2013.

A Waterloo city employee also filed an affidavit in support of the application, stating A.S.R. had visited city hall "demanding to see people" and acting "very paranoid, talking of taking justice his way." These documents expressed concern A.S.R. would injure others.

The judicial hospital referee held a hearing on February 19, 2013. Dr. James Trahan, the physician who examined A.S.R., diagnosed A.S.R. as having delusional disorder. The doctor reached this conclusion based on statements by A.S.R. concerning a large-scale conspiracy preventing him from collecting insurance benefits and delusional beliefs concerning the wrongdoing of law enforcement and city employees. Dr. Trahan opined A.S.R. was not capable of making responsible decisions regarding hospitalization or treatment because A.S.R. does not believe he has an illness. A.S.R. has refused to take medication. The doctor testified A.S.R.'s circumstances suggest he suffered from a chronic mental illness and had "a bit of a flare-up" recently. Also at the hearing, Chief Trelka testified A.S.R. told him on February 7, 2013, "if not for the belief [A.S.R.] has in God, there would have been a mass murder based on what [A.S.R.'s] been through in life."

In an order filed February 20, 2013, the judicial hospitalization referee determined A.S.R. was seriously mentally impaired. The referee ordered outpatient treatment at the Black Hawk-Grundy Mental Health Center, telling A.S.R. "which just means that you check in with them." The referee also advised A.S.R. "if you're court-ordered to treatment, you're ordered to take medications as prescribed." A.S.R. appealed to the district court. In response to the appeal, the executive director, the medical director, a social worker, and an advanced nurse practitioner from the Black-Hawk-Grundy Mental Health Center drafted a letter concerning their evaluation of A.S.R. The letter recommended continued commitment based on the "inherent risk" associated with A.S.R.'s diagnosis of delusional disorder and his "naming of specific individuals who have conspired against him." The medical staff considered A.S.R.'s recent applications for weapons permits and stated "in their professional opinion" the combination of circumstances could be a "recipe for disaster."

The district court held a hearing on March 18, 2013, and affirmed the order of the judicial hospitalization referee ...

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